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目的探讨前额底脑挫裂伤的手术时机。方法回顾性分析我院自1998年7月至2005年5月收治的前额底脑挫裂伤并施行手术的病例。结果入院即行手术(含24h内)14例为A组;初期保守治疗,24h后手术24例为B组。入院时GCS:A组平均6.5分,B组平均13分。随访半年并根据GOS判定:A组康复良好8例(57.1%),中度残废3例(24.1%),重度残废2例(14.3%),死亡1例(7.1%);B组康复良好8例(33.3%),中度残废5例(20.8%),重度残废7例(29.2%),死亡4例(16.7%)。入院时A组GCS普遍低于B组,GOS结果A组良好率高于B组,A组重残率、死亡率低于B组,具有显著统计学差异(P<0.05)。结论前额底脑挫裂伤早期(24h以内)明确手术指征,筛选出可能恶化的病例并及时手术对改善前额叶底脑挫裂伤的预后具有积极意义。
Objective To investigate the timing of surgery for contusion and laceration of the forehead. Methods A retrospective analysis of our hospital from July 1998 to May 2005 were treated forehead contusion and laceration of the brain cases of surgery. Results The patients were admitted to hospital for operation (including 24h) 14 cases were in group A; initial conservative treatment, 24 hours after operation 24 cases were in group B. On admission, GCS: A group average 6.5 points, B group average 13 points. Six months follow-up and according to GOS, 8 cases (57.1%) were well recovered in group A, 3 cases (24.1%) were moderate disability, 2 cases were severe disability (14.3%) and 1 case died (7.1%). (33.3%), moderate disability in 5 cases (20.8%), severe disability in 7 cases (29.2%) and death in 4 cases (16.7%). The GCS of patients in group A were generally lower than those in patients in group B. The good rate of GOS in group A was higher than that in group B. The severe disability and mortality in group A were lower than those in group B (P <0.05). Conclusion It is of great significance to clarify the indications for surgery in the early (within 24 hours) contusion and demarcation of forehead and to screen out the possible cases of exacerbation and timely surgery to improve the prognosis of prefrontal lobe cerebral contusion and laceration.