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目的探讨双侧去骨瓣减压开颅术治疗重型对冲性颅脑外伤的效果。方法选取北京朝阳急诊抢救中心脑系科2011年9月—2013年9月收治的85例重型对冲性颅脑外伤住院患者,采用随机数字表法将患者分组,单侧组42例给予常规单侧外伤大骨瓣减压术治疗,双侧组43例给予双侧去骨瓣减压开颅术治疗,观察颅内压变化和随访3个月预后情况。结果术前两组患者颅内压比较,差异无统计学意义(P>0.05);术后双侧组颅内压均低于单侧组,差异有统计学意义(P<0.05)。双侧组术后恢复良好率(55.81%)高于对照组(33.33%),差异有统计学意义(P<0.05)。双侧组术后并发硬膜下积液和感染并发症发生率低于单侧组,差异有统计学意义(P<0.05)。结论双侧去骨瓣减压开颅术治疗重型对冲性颅脑外伤效果确切,能够有效降低和控制颅内压,促进功能恢复,在降低手术并发症和改善预后等方面具有重要意义。
Objective To investigate the effect of bilateral craniotomy decompression craniotomy on severe hemorrhagic head injury. Methods Eighty-five inpatients with severe traumatic brain injury admitted from September 2011 to September 2013 in Beijing Chaoyang Emergency Rescue Center were enrolled. Patients were divided into two groups according to random number table. Forty-two patients in unilateral group were given conventional unilateral Traumatic big bone flap decompression treatment, bilateral group of 43 cases were given bilateral craniotomy decompressive craniotomy, intracranial pressure changes and follow-up of 3 months prognosis. Results There was no significant difference in intracranial pressure between the two groups before surgery (P> 0.05). The intracranial pressure in both groups was lower than that in unilateral group (P <0.05). The good rate of postoperative recovery in both groups (55.81%) was higher than that in control group (33.33%), the difference was statistically significant (P <0.05). The incidence of postoperative complications of subdural effusion and infection in both groups was significantly lower than that in unilateral group (P <0.05). Conclusion Bilateral craniotomy decompression craniotomy for severe hemorrhagic head injury has the exact effect, which can effectively reduce and control the intracranial pressure and promote functional recovery, reducing the complications and improving the prognosis of great significance.