[1]段继新　石　磊　钟治军　王　承　吴　云　韩　令　于汉昌　刘　渊.T型切口在复杂颅脑损伤急诊开颅术中的应用[J].中国临床神经外科杂志,2019,(09):535-536.[doi:10.13798/j.issn.1009-153X.2019.09.007]
　DUAN Ji-xin,SHI Lei,ZHONG Zhi-jun,et al.Application of T-shaped incision in craniotomy for patients with complicated traumatic brain injury[J].,2019,(09):535-536.[doi:10.13798/j.issn.1009-153X.2019.09.007]
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T型切口在复杂颅脑损伤急诊开颅术中的应用()

《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
期数:
2019年09期
页码:
535-536
栏目:
论著
出版日期:
2019-09-20

文章信息/Info

Title:
Application of T-shaped incision in craniotomy for patients with complicated traumatic brain injury
文章编号:
1009-153X（2019）09-0535-02
作者:
段继新　石　磊　钟治军　王　承　吴　云　韩　令　于汉昌　刘　渊
410100，长沙市中医医院（长沙市第八医院）神经外科（段继新、石　磊、钟治军、王　承、吴　云、韩　令、于汉昌、刘　渊）
Author(s):
DUAN Ji-xin;  SHI Lei;  ZHONG Zhi-jun;  YU Han-chang;  LIU Yuan;  HAN Ling;  WANG Cheng;  WU Yun
Department of Neurosurgery, Changsha Municipal Traditional Chinese Medicine Hospital, Changsha 410100, China
关键词:
复杂颅脑损伤; 颅内多发血肿; 双侧开颅; T型切口
Keywords:
Complicated traumatic brain injury;  Multiple intracranial hematoma;  Bilateral craniotomy;  T-shaped incision
分类号:
R 651.1+5; R 651.1+1
DOI:
10.13798/j.issn.1009-153X.2019.09.007
文献标志码:
A
摘要:
目的 探讨T型切口在复杂颅脑损伤急诊开颅手术中的应用效果。方法 回顾性分析2016年8月至2018年3月应用T型切口进行开颅手术救治的42例复杂颅脑损伤的临床资料。42例均急诊进行开颅探查+血肿清除术，根据术前头部CT表现均选择T型切口，其中第一次手术双侧T型切口15例，术中按照阶梯减压执行，双侧开颅采用双侧控制技术。结果 双侧硬膜下血肿7例，双侧硬膜外血肿2例，双侧脑挫裂伤伴脑内血肿5例，一侧硬膜外血肿合并对侧脑挫裂伤伴脑内血肿或硬膜下血肿9例，一侧硬膜下血肿合并对侧脑挫裂伤伴脑内血肿或硬膜外血肿19例。术后2例颅后窝开颅切口处因是直接着力点，愈合差，经重新缝合及换药处理均愈合；其他40例伤口愈合良好。术后1周神志好转25例，神志清楚6例，无变化11例；术后1个月神志好转18例，神志清楚14例。术后3个月按GOS评分评估预后：恢复良好11例，中残15例，重残2例，植物状态6例，死亡8例。结论 在复杂颅脑损伤急诊手术中，特别是需要双侧开颅手术时，以及可能出现进展、变化的病例，T型切口具有一定的优势，有助解决复杂颅脑损伤急诊开颅手术中的切口设计难题。
Abstract:
Objective To investigate the outcomes and indications of craniotomy with T-shaped incision in the patients with complicated traumatic brain injury (CTBI). Methods The clinical data of 42 patients with CTBI, who underwent craniotomy with T-shaped incision from August, 2016 to March, 2018, were analyzed retrospectively. All the patients underwent emergency craniotomy under general anesthesia. Of 42 patients, 15 underwent bilateral T-shaped incisions craniotomy according to the gradient decompression and bilateral control technology and 27 unilateral T-shaped incisions craniotomy according the gradient decompression. Results Of 42 patients, 11 (26.2%) were recovered well, 15 (35.7%) medially disabled, 2 (4.8%) severely disabled, 6 (14.3%) vegetatively survived, and 8 (19%) died according to GOS score 3 months after the operation. Conclusion The T-shaped incision had certain advantages in the patients with CTBI, especially in the patients with progressive CTBI or needing bilateral craniotomy because it may solve the problem of incision design of craniotomy for the complex traumatic intracranial hematomas.

参考文献/References:

[1] 钟治军，段继新. 梯度减压技术在急性重型颅脑损伤术的疗效分析[J]. 湘南学院学报：医学版，2015，17（4）：27-29.[2] Brian TR, Paul KJ, Jonathan EM. Wartime decompressive craniectomy: technique and lessons learned [J]. Neurosurg Focus, 2010, 28(5): E2. [3] Surgical management of traumatic brain injury [M]. In: Winn HR ed. Youmans neurological surgery. Philadelphia PA: W. B. Saunders, 2011. 3424-3452.[4] 邵　军，贾文庆，毛雪军，等. M型切口双侧同时开颅在治疗脑疝中应用[J]. 浙江创伤外科，2013，18（4）：498-499.[5] 张士中. 不同手术入路治疗双侧额叶脑挫裂伤伴颅内血肿疗效观察[J]. 中国实用神经疾病杂志，2013，16（7）：81-82[6] 丘学才，常　巍，张丽娟，等. 双侧开颅去骨瓣减压术治疗对冲性重型颅脑损伤疗效观察[J]. 山东医药，2010，50（2）：60-61.[7] 黄国河，吴国鑫，林诗荣，等. 双额颞部开颅减压治疗弥漫性脑肿胀双侧脑疝[J]. 临床军医杂志，2015，43（10）：1016-1018.

备注/Memo

备注/Memo:
（2019-03-27收稿，2019-07-25修回）
更新日期/Last Update: 2019-09-20