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Efficacy of standard large trauma craniectomy for severe traumatic brain injured patients with tentorial herniation:a multicenter prospective randomized controlled study
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- Author:
- No author available
- Journal Title:
- CHINESE JOURNAL OF NEUROSURGERY
- Issue:
- 1
- DOI:
- 10.3760/j.issn:1001-2346.2004.01.010
- Key Word:
- 重型颅脑损伤;标准外伤大骨瓣;常规颞顶瓣;预后
Abstract： 目的比较标准外伤大骨瓣与常规颞顶瓣开颅术在治疗447例重型颅脑损伤合并脑挫裂伤脑水肿、恶性颅内高压病人的效果.方法 6家医院神经外科共收治符合标准的重型颅脑损伤病人447例,分为两组:(1)标准外伤大骨瓣组217例;(2)常规骨瓣组230例.所有病人都经CT扫描证实颅内损伤状况.结果伤后6个月临床随访结果:标准外伤大骨瓣组:76例预后较好(35.0%),其中恢复良好42例、中残34例;141例预后较差(65.0%),其中重残69例、植物生存9例、死亡63例;常规骨瓣组:58例预后较好(25.2%),其中恢复良好31例、中残27例;172例预后较差(74.8%),其中重残80例、植物生存7例、死亡85例(P＜0.05).标准外伤大骨瓣治疗组病人颅内压下降速度和程度优于常规骨瓣对照组(P＜0.05).标准外伤大骨瓣治疗组病人的迟发性血肿、再次手术、切口疝和脑脊液漏发生率明显低于常规骨瓣对照组(P＜0.05),但两组病人术后急性脑膨出、术后外伤性癫痫和颅内感染发生率均无显著差异(P＞O.05).结论临床前瞻性多中心对照研究证明标准外伤大骨瓣开颅术治疗严重脑挫裂伤脑水肿、恶性颅内高压病人的疗效优于常规颞顶瓣开颅术.
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