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目的探讨标准外伤大骨瓣改良术治疗老年人重型颅脑损伤的效果。方法选取南宁市第八人民医院2010年10月—2015年5月诊治的老年人重型颅脑损伤患者102例,按照随机数字法分为两组,各51例。观察组采用标准外伤大骨瓣改良术治疗,对照组采用常规开颅手术治疗,对比两组患者手术前后不同时间的颅内压、并发症发生率和预后情况。结果术前两组患者颅内压水平比较,差异无统计学意义(P>0.05)。术后1d、1周、2周观察组颅内压水平均低于对照组,差异有统计学意义(P<0.05)。观察组患者恢复良好率、中度残疾率均高于对照组,而重度残疾率、植物生存率和病死率均低于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率为7.8%(4/51),低于对照组的31.4%(16/51),差异有统计学意义(P<0.01)。结论标准外伤大骨瓣改良术治疗老年人重型颅脑损伤效果显著,可持续降低患者术后颅内压,并减少术后并发症,改善其预后,安全可靠,适宜老年人重型颅脑损伤患者应用。
Objective To investigate the effect of standard traumatic big bone flap in the treatment of severe craniocerebral injury in the elderly. Methods A total of 102 elderly patients with severe traumatic brain injury who were diagnosed and treated in the Eighth People’s Hospital of Nanning from October 2010 to May 2015 were divided into two groups (n = 51) according to the random number method. The observation group was treated with standard malformation of large bone flap, while the control group was treated by conventional craniotomy. The intracranial pressure, the incidence of complications and the prognosis of the two groups were compared before and after surgery. Results There was no significant difference in intracranial pressure between the two groups before operation (P> 0.05). The levels of intracranial pressure in the observation group at 1 day, 1 week and 2 weeks after operation were significantly lower than those in the control group (P <0.05). In the observation group, the rate of recovery was good, the rate of moderate disability was higher than that of the control group, while the rate of severe disability, plant survival and mortality were lower than that of the control group. The difference was statistically significant (P <0.05). The incidence of complications in the observation group was 7.8% (4/51), which was lower than that in the control group (31.4%, 16/51). The difference was statistically significant (P <0.01). CONCLUSIONS: The treatment of severe craniocerebral injury with standard trauma and large bone flap is significant in the treatment of severe craniocerebral injury in the elderly, which can reduce the postoperative intracranial pressure, reduce the postoperative complications and improve the prognosis, and is safe and reliable. It is suitable for elderly patients with severe craniocerebral injury application.