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目的探讨采用标准外伤大骨瓣开颅血肿清除并侧裂池减压,术中对天幕裂孔疝患者行天幕切开脑疝复位术治疗急性重度颅脑外伤并侧裂区损伤的临床意义。方法 31例急性重度颅脑伤并侧裂区损伤患者(格拉斯哥昏迷评分GCS≤8分),采用标准外伤大骨瓣开颅血肿清除去骨瓣减压后,在显微镜下将侧裂池蛛网膜切开,冲洗引流,敞开侧裂池充分减压,对术前天幕裂孔疝患者行天幕切开并复位。结果 12个月全部病例获得随访,随访MRI+MRV检查:侧裂区水肿消退,侧裂区静脉回流畅顺。术后生存25例,生存率为80.6%,死亡6例,死亡率为19.4%;GOS评分:恢复良好19例,中残3例,重残2例,植物生存1例。结论采用标准外伤大骨瓣开颅血肿清除去大骨瓣减压、侧裂池减压并天幕裂孔疝复位术能提高急性重度颅脑外伤并侧裂区损伤,可提高生存率、降低死残率、提高生存质量,值得临床推广应用。
Objective To explore the clinical significance of using standard trauma craniectomy and lateral fissure decompression in patients with atrial fissure hernia and intraocular hernia repair underwent surgery to treat acute severe traumatic brain injury and lateral fissure area. Methods 31 patients with severe acute craniocerebral injury and lateral fissure injury (Glasgow coma score GCS ≤ 8), using standard trauma craniectomy craniotomy removal of bone flap decompression, under the microscope will split the spider arachnoid Open, flush drainage, open side fissure pool full decompression, preoperative rupture of the hiatal hernia patients cut open and reset. Results All cases were followed up for 12 months. MRI + MRV examination was followed up: edema of the lateral fissure area subsided and the venous return in the lateral fissure area was smooth. Survival in 25 cases, the survival rate was 80.6%, 6 died, the mortality rate was 19.4%; GOS score: good recovery in 19 cases, 3 cases of severe disability in 2 cases, 1 case of plant survival. Conclusions The treatment of severe traumatic hematoma with craniectomy can relieve the decompression of large bone flap, decompression of lateral cleft cell and hernia hiatal hernia restoration can improve acute severe traumatic brain injury and injury of lateral fissure area, which can improve the survival rate and reduce the death Rate, improve the quality of life, it is worth clinical application.