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目的:对比分析额部骨瓣开颅联合颞肌下减压术与单纯额部开颅减压术防治中央型脑疝的效果。方法:将我院收治的30例额叶脑挫裂伤患者随机均分为两组,行动态头部CT检查,予相同保守治疗,在中央型脑疝代偿期,观察组行额部骨瓣开颅联合颞肌下减压术,对照组行单纯额部开颅减压术。对比两组手术效果、清创效果、并发症情况及术后神经功能恢复情况。结果:观察组手术时间、手术切口明显更长(P<0.05),两组术中出血量无明显差异;两组初始颅内压无明显差异,术后观察组颅内压明显低于对照组(P<0.05);观察组并发症出现率明显低于对照组(P<0.05),术后GOS评分分层对比明显优于对照组(P<0.05)。结论:额部骨瓣开颅联合颞肌下减压术对预防额叶脑挫裂伤并发中央型脑疝效果确切,有助于稳定患者颅内压,促进术后神经功能恢复,值得关注。
Objective: To compare the effect of frontal cranial flap craniotomy combined with submuscular decompression and simple forehead craniotomy to prevent and treat central hernia. Methods: Thirty patients with frontal lobe contusion and laceration treated in our hospital were randomly divided into two groups. The patients underwent dynamic head CT examination and were given the same conservative treatment. During the compensatory period of central hernia, Flap craniotomy combined with temporal myofascial decompression, the control group were simple craniotomy decompression. Compare the two groups of surgical results, debridement effect, complications and postoperative recovery of neurological function. Results: The operative time and operative incision in the observation group were significantly longer (P <0.05), and there was no significant difference in intraoperative blood loss between the two groups. The initial intracranial pressure had no significant difference between the two groups. The intracranial pressure in the observation group was significantly lower than that in the control group (P <0.05). The incidence of complications in the observation group was significantly lower than that in the control group (P <0.05). The postoperative GOS score was significantly better than that in the control group (P <0.05). Conclusion: Frontal craniotomy combined with submuscular decompression is effective for the prevention of frontal lobe contusion and laceration with central hernia. It is helpful to stabilize the intracranial pressure and promote the recovery of postoperative neurological function, which deserves attention.