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Objective To investigate the effect of progressive decompression on neurological function, long-term prognosis and complications in patients with severe craniocerebral injury undergoing modified large trauma craniotomy. Methods From January 2015 to January 2017, ninety patients with severe craniocerebral injury treated in Leizhou Shi People Hospital were selected and were randomly divided into the observation group (45 cases) and the control group (45 cases). The patients in the control group were treated with conventional decompression during the modified large bone flap decompression, and the patients in the observation group were treated with progressive decompression in the modified large bone flap decompression. The Glasgow Coma Scale (GCS) was used to evaluate the degree of damage before treatment and at 1d,3d,5 d,7d,14d, 30d after treatment,the intracranial pressure was monitored before treatment, at the surgical end, and at 1 d, 3 d, 5 d after surgery, the Glasgow′s prognostic score (GOS) was evaluated at 3 months after treatment. the neurobehavioral cognitive state checklist score ( NCSE) and the daily living ability score ( Barthel index ) were performed at 6 months after the operation, and the incidence of postoperative complications was recorded. Results The GCS scores of the observation group and the control group at 3d after treatment were respectively (5.70±0.82) points and (5.05±0.70) points], at 5d after treatment were (7.45±1.12) points and (5.81±0.82) points, at 7d after treatment were (9.38±0.52) points and (6.64±0.65) points, at 14 d after treatment were (10.31±0.79) points and (7.86±0.53) and at 30 d after treatment were (12.79±1.03) points and (10.13±1.31 points),which significantly higher than those before operation ((4.11±0.40), (4.15±0.42) points)(P＜0.05), and the scores of the observation group were significantly higher than those of the control group at each time interval ( P＜0.01). The intracranial pressure in the observation group and the control group were (26.64 + 3.02) and (29.79±2.57) mmHg respectively, (22.88±2.49) and (26.03±3.75) mmHg respectively at 1d after operation, (17.36±1.73) and (24.40±3.07) mmHg at 3d after operation.(14.20±1.18)mmHg and(21.06±2.64)mmHg at 5s after operation, All of them were significantly lower than that before operation (( 31.36 + 4.30) , ( 31.30 ±4.11) mmHg) (P＜0.05), and each time of the observation group was significantly lower than that of the control group (P＜0.01). The good recovery rate of the observation group was 22.22%(10/45), which was significantly higher than that of the control group (6.67%(3/45)). The difference between the two groups was statistically significant (χ2＝4.406, P＜0.05), the plant survival rates in the two groups were 4.44%(2/45) and 20%(9/45) respectively, the mortality rates were 13.33%(6/45) and 31.11%(14/45) respectively, and the two groups had statistical significance.(χ2＝5.050, 4.114, P＜0.05).The NCSE of the observation group and the control group were (69.24±8.42) points and (51.57±6.35) points at 6 months after operation, and the Barthel index was (76.97±5.57)points and (68.24±6.02)points respectively. The observation group was significantly higher than the control group ( t＝10.524, 8.713, P＜0.05). The total incidence of complications in the observation group was 24.44%( 11/45), which was significantly lower than that in the control group (60%) (27/45), and the difference was statistically significant (χ2＝11.660, P＜0.05). Conclusion It is more valuable to use progressive decompression in modified large bone flap decompression for severe craniocerebral injury, which can effectively protect the nerve function, reduce the incidence of complications in the perioperative period, and improve the effect of long－term prognosis.
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Objective To explore the surgical techniques and clinical outcome of standard large trauma craniotomy in the treatment of acute subdural hematoma.Methods The clinical data of 51 cases with acute subdural hematoma,who underwent standard large trauma craniotomy in recent 5 years in our department,were retrospectively analyzed.Results All the patients were followed up for 3 ～ 6 months.10 cases were dead,4 persistent vegetative status,severe disability in 6 cases,midrange disability occurred in 11 cases and 20 cases were good.Postoperative complications included tardive haematoma in 4 cases,traumatic cerebral infarction in 2 cases,subdural collection of fluid in 4 cases,cerebromalacia in depressor area in 2 cases,hydrocephalus in 2 cases,and traumatic epilepsy in 3 cases.Conclusion Standard large trauma craniotomy is an effective approach in the treatment of acute subdural hematoma,due to its advantages such as satisfactory exposure for haemostasis,rapid removal of haematoma and relief of acute intracranial hypertension.
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ObjectiveTo explore the efficacy of large trauma craniotomy with bilateral frontal coronal incision in treating contusion and laceration of bilateral frontal lobes.MethodsThe clinical data of 68 patients with contusion and laceration of bilateral frontal lobes who were treated with bilateral decompressive craniectomy were analyzed retrospectively.There were 36 cases(observation group) treated with large trauma craniotomy with bilateral frontal coronal incision and 32 cases (control group) given bilateral decompressive craniectomy by stages.The prognosis of two groups were observed and compared.The prognosis was evaluated at 6 months after surgery by Glasgow outcome scale (GOS) score.ResultsThere were 23 cases (63.89％,23/36) who got good recovery,8 cases(22.22％,8/36) with poor prognosis and 5 dead cases (13.89％,5/36) in observation group.There were 11 cases (34.38％,11/32) who got good recovery,9 cases (28.12％,9/32) with poor prognosis and 12 dead cases (37.50％,12/32) in control group.The rate of good recovery and mortality between two groups had significant differences (P ＜ 0.05).ConclusionsThe large trauma craniotomy with bilateral frontal coronal incision can significantly relieve or ease intracranial hypertension of patients with contusion and laceration of bilateral frontal lobes.And it can improve the prognosis and decrease the mortality.
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Objective To evaluate the therapeutic efficacy of the method of standard large trauma craniotomy in combination with therapeutic moderate hypothermia.Method Patients with acute severe head injuries (GCS≤8)were assigned into two groups:Group I,30 cases(average GCS≤ 5.38) received standard large trauma craniotomy and moderate hypothermia for 5-7 days;Group Ⅱ,30 cases(average GCS≤5.46)were treated with traditional treatment as control.Mortality,GCS,GOS and intracranial pressure (ICP) were compared between these two groups.Result Both the GCS and GOS were higher in the group Ⅰ than group Ⅱ;while the mortality and ICP were obviously lower in the group Ⅰ than that of the control group.Conclusions Early standard large trauma craniotomy plus adequate decompression followed by postoperative therapeutic moderate hypothermia would be helpful in reducing the mortality moderate and morbidity of patients with severe head injuries,their level of living accommodation were improved as well.
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Objective To evaluate the value of standard large trauma craniotomy in frontotemporal and parietal contrecoup craniocerebral injury.Methods Forty-six patients with frontotemporal and parietal contrecoup craniocerebral injury were treated by standard large trauma craniotomy. Based on GOS, the clinical curative effect and complications of these patients during 3 to 6 months after operation were evaluated.Results 22 cases (47.83%) recovered well, 6 cases (13.04%) suffered from moderate disability, 4 cases (8.7%) remained severe disability, and 14 cases (30.43%) died. The common complications after operation were delayed intracranial hematoma, cerebral penetrating malformation, hydrocephalus, defect of skull syndrome and so on.Conclusion Standard large trauma craniotomy is a good therapeutic method for frontotemporal and parietal contrecoup craniocerebral injury.