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目的:探讨额颞部脑挫裂伤的治疗方法及体会。方法:回顾分析我院2007年—2011年收治的106例额颞部脑挫裂伤患者的临床资料,其中,双侧额颞部脑挫裂伤35例,一侧脑挫裂伤71例。入院时GCS评分3—8分32例,其中,脑挫裂伤体积大于20cm3且中线移位大于5mm17例,大于50cm311例;9—12分45例,其中,脑挫裂伤体积大于20cm且中线移位大于5mm6例;13—15分27例。车祸伤52例,坠落伤12例,打击伤7例,枕顶部及颞部(对冲伤)65例,额颞部伤13例,其他部位伤5例。结果:手术治疗51例,非手术治疗57例,恢复良好41例,中残21例,重残5例,死亡4例。结论:脑挫裂伤为枕顶部伤及额部对冲伤,该类患者早期临床症状较轻或无明显临床症状及体征,但病程中容易引起迟发性脑内血肿及脑水肿、脑肿胀,病情变化快,预后差,致残率及死亡率高,因此,在治疗过程中需密切观察病情变化,特别是神志意识障碍加重或出现昏迷、瞳孔改变,CT检查提示脑挫裂伤体积大于20cm3且中线移位大于5mm;伴或不伴基底池受压及显示不清,甚或脑疝形成时,应及时进行手术治疗。
Objective: To explore the treatment of frontotemporal contusion and laceration and experience. Methods: The clinical data of 106 patients with frontotemporal contusion and laceration treated in our hospital from 2007 to 2011 were analyzed retrospectively. Among them, 35 cases were frontotemporal contusion and 71 cases cerebral contusion in one side. On admission, GCS score was 3-8 points in 32 cases, of which, contusion and laceration of the brain was larger than 20cm3 and midline shift was greater than 5mm17 cases, greater than 50cm311 cases; 9-12 points and 45 cases, of which contusion and laceration volume was greater than 20cm and midline Transposition greater than 5mm6 cases; 13-15 points in 27 cases. Traffic accident in 52 cases, fall injury in 12 cases, hit injury in 7 cases, pillow top and temporal (impact injury) in 65 cases, frontotemporal injury in 13 cases, other parts of the injury in 5 cases. Results: Surgical treatment of 51 cases, 57 cases of non-surgical treatment, good recovery in 41 cases, 21 cases of disability, severe disability in 5 cases, 4 patients died. Conclusion: The contusion and laceration of the brain is the head injury and frontal impact injury. The early clinical symptoms of these patients are mild or no obvious clinical symptoms and signs, but the course of the disease easily lead to delayed intracerebral hematoma and cerebral edema, brain swelling, The condition changes fast, the prognosis is poor, the morbidity and mortality rate is high, therefore, in the course of treatment should be closely observed changes in condition, especially the consciousness disorder aggravated or coma, pupil changes, CT examination tips cerebral contusion and laceration volume greater than 20cm3 And the median shift greater than 5mm; with or without base pool pressure and display unclear, or even when the formation of cerebral hernia, surgical treatment should be promptly.