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目的探讨脑疝复位技术或天幕裂孔切开术对外伤后嵌顿性颞叶钩回疝的救治效果。方法对56例外伤性颅内血肿合并脑疝者应用脑疝复位技术或天幕裂孔切开处理嵌顿性颞叶钩回疝,并与29例常规手术对照组患者进行比较。结果脑疝复位组56例中,恢复良好25例,中残7例,重残5例,迁延性昏迷4例,死亡15例;预后较好(良好+中残)者占57.1%(32/56),死亡率为26.8%(15/56)。常规手术对照组29例中恢复良好5例,中残2例,重残5例,迁延性昏迷3例,死亡14例;预后较好(良好+中残)者占24.1%(7/29),死亡率为48.3%(14/29)。两组患者死亡率及恢复较好(良好+中残)者所占比例与对照组比,有显著性差异(P<0.05)。结论发生脑疝嵌顿时,对于单侧瞳孔散大时间在2h以上,或已经出现双侧瞳孔散大但持续时间在1h以内者,结合脑疝复位或天幕裂孔切开术,能显著改善病人的预后。
Objective To investigate the effect of cerebral hernia reduction technique or canopy hole incision on the treatment of incarcerated temporal lobe hernia after traumatic injury. Methods 56 cases of traumatic intracranial hematoma complicated with cerebral hernia were treated by cerebral hernia reduction technique or cantilever hole incision to treat incarcerated temporal lobe hernia and compared with 29 cases of routine surgery control group. Results In the 56 cases of hernia repair group, 25 cases were recovered well, 7 cases were moderate disability, 5 cases were severe disability, 4 cases were prolonged coma, and 15 cases died. The patients with good prognosis (57%) had good prognosis 56) with a mortality rate of 26.8% (15/56). In the routine operation control group, 5 cases were recovered well in 2 cases, 2 cases were moderate disability, 5 cases were severe disability, 3 cases were prolonged coma, and 14 cases died; 24.1% (7/29) had good prognosis. , The mortality rate was 48.3% (14/29). There was a significant difference between the two groups in mortality and recovery (good + moderate residual) compared with the control group (P <0.05). Conclusions In the event of hernia incarceration, unilateral mydriasis for more than 2h, or have bilateral mydriasis but the duration of less than 1h, combined with hernia repair or canopy hole opening can significantly improve the patient’s Prognosis.