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目的探究双额大骨瓣减压术治疗脑外伤后难治性弥漫性脑肿胀的效果。方法 68例脑外伤后难治性弥漫性脑肿胀患者,根据手术方法不同分成研究组(35例)和对照组(33例)。对照组给予保守降颅压治疗,研究组给予双额大骨瓣减压术治疗。比较两组患者格拉斯哥预后评分(GOS)以及并发症发生情况。结果随访6个月后,研究组预后较好率45.71%高于对照组21.21%,差异具有统计学意义(P<0.05)。研究组术后出现2例硬膜下积液,给予脑脊液引流处理5~7 d后明显好转,1例术后1个月出现脑积水,给予右侧脑室-腹腔分流术后意识恢复,本次研究无脑脊液漏以及颅内感染的发生。结论双额大骨瓣减压术对难治性弥漫性脑肿胀具有明显的疗效,能够显著降低患者的颅内压,减少并发症的发生,适合推广。
Objective To investigate the effect of double forelimb decompression on intractable diffuse brain swelling after traumatic brain injury. Methods Sixty-eight patients with intractable diffuse brain swelling after traumatic brain injury were divided into study group (35 cases) and control group (33 cases) according to different surgical methods. The control group was given conservative treatment of intracranial pressure, and the study group was treated with double forehead decompression. Glasgow prognostic score (GOS) and complications were compared between the two groups. Results After 6 months’ follow-up, the good prognosis of the study group was 45.71% higher than that of the control group (21.21%), the difference was statistically significant (P <0.05). In the study group, 2 cases of subdural effusion occurred after operation, and cerebrospinal fluid drainage was improved after 5 ~ 7 days. One case had hydrocephalus at 1 month after operation and recovered consciousness after right ventricle-peritoneal shunt No study of cerebrospinal fluid leakage and intracranial infection occurred. Conclusions Double amount of large bone flap decompression has obvious curative effect on refractory diffuse brain swelling, can significantly reduce the intracranial pressure and reduce the occurrence of complications, and is suitable for popularization.