硬脑膜严密扩大缝合对特重型颅脑损伤开颅去骨瓣减压患者效果探究.docVIP

硬脑膜严密扩大缝合对特重型颅脑损伤开颅去骨瓣减压患者的效果分析 　　[摘要] 目的 探讨硬脑膜严密扩大缝合对特重型颅脑损伤开颅去骨瓣减压患者的效果分析。 方法 回顾性分析2013年1月―2015年1月该院收住的102例特重型颅脑损伤患者单侧标准外伤大骨瓣减压后随机分组行硬脑膜严密扩大缝合（研究组52例）和敞开硬脑膜（对照组50例）患者的临床资料，比较两组术后头皮切口脑脊液漏发生率、癫痫发生率以及伤后1年的格拉斯哥预后评分（GOS）等参数。结果 研究组、对照组术后头皮切口脑脊液漏发生率分别为1.9%（1/52）和12%（6/50）（P0.05），差异均有统计学意义。结论 采用硬脑膜严密扩大缝合能降低特重型颅脑损伤去骨瓣减压患者头皮切口漏发生率、晚期癫痫发生率，提高治疗有效率 [关键词] 特重型颅脑损伤；硬脑膜；扩大缝合；减压术 [中图分类号] R4 [文献标识码] A [文章编号] 1674-0742（2016）08（c）-0131-04 Tension-reduced Suture of Dura Mater for Cerebral Protection Following Decompressive Craniectomy of Severe Craniocerebral Trauma TANG Ming-zhang，CHEN Li Department of Neurosurgery，Ningde municipal Hospital affiliated to Fujian， Medical University， Ningde， Fujian Province，352100 China [Abstract] Objective To investigate the clinical effects of tension suture of dura-mater after decompressive craniectomy in severe craniocerebral trauma. Methods The study retrospectively analyzed severe craniocerebral trauma patients managed with standard decompressive craniectomy in the presence（study group，n=52）or absence of dura-mater close（control group，n=50） randomly from January 2013 to January 2015 in our hospital，clinical data， such as incision leakage of cerebrospinal fluid，morbidity of epilepsy，Glasgow Outcome Scale（GOS）12 months after injury. Results The incidence of incision leakage of cerebrospinal fluid was 1.9%（1/52） in study group and 12%（6/50）in control group（P0.05），the difference was statistically significant. Conclusion To close the dura-mater by tension-reduced suture following decompressive craniectomy of severe craniocerebral trauma reduce incision leakage of cerebrospinal fluid，morbidity of epilepsy and improves the clinical efficacy. [Key words] Severe craniocerebral trauma ； Dura mater； Tension-reduced suture； Decompressin 颅脑损伤是一种常见的多发病，随着交通工具的普及、建筑业的发展、体育竞技的增多，颅脑损伤发病率有增加趋势[1]。颅脑损伤是一种高致残率、高死亡率的疾病，开颅清除血肿是颅脑损伤有效治疗手段之一，对于中度、重度颅脑损伤患者，如有打开硬脑膜清除血肿手术，目前大家公认应该进行硬脑膜缝合，恢复机体正常生理结构，但对于特重型颅脑损伤，因为严重脑肿胀、颅高压，部分人主张硬脑膜严密扩大缝合，部分人主张硬脑膜不缝合，敞开