Clinical application value of craniotomy with hematoma evacuation combined with decompressive craniectomy in the treatment of severe traumatic brain injury
10.3760/cma.issn1008-6706.2021.07.012
- VernacularTitle:开颅血肿清除术联合去骨瓣减压术治疗重型颅脑损伤的临床应用价值分析
- Author:
Hao WANG
1
;
Juanjuan XUAN
;
Yannan YANG
;
Qianli ZHANG
;
Jun YAO
;
Yayun WU
Author Information
1. 武警海警总队医院重症医学科,浙江省嘉兴 314000
- Keywords:
Craniocerebral trauma;
Craniotomy;
Decompression,surgical;
Hematoma,epidural,cranial;
Postoperative complications;
Nerve injuries;
Reoperation;
Activities of
- From:
Chinese Journal of Primary Medicine and Pharmacy
2021;28(7):1010-1014
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical application value of craniotomy with hematoma evacuation combined with decompressive craniectomy in the treatment of severe traumatic brain injury.Methods:Sixty-eight patients with severe traumatic brain injury who received treatment in China Coast Guard Bureau Hospital, China between June 2016 and June 2019 were randomly assigned to receive either craniotomy with hematoma evacuation combined with decompressive craniectomy (observation group, n = 34) or conventional craniotomy (control group, n = 34). Surgical value for severe traumatic brain injury and the occurrence of complications were compared between the observation and control groups. Results:Before treatment, there were no significant differences in intracranial pressure, National Institute of Health Stroke Scale score, activity of daily living between the observation and control groups (all P > 0.05). After 7 days of treatment, intracranial pressure in the two groups was significantly decreased compared with before treatment, and intracranial pressure in the observation group was significantly lower than that in the control group ( t = 17.284, P < 0.001). After treatment, Glasgow Coma Scores were significantly increased in the two groups, and Glasgow Coma Scores in the observation group were significantly higher than those in the control group ( t = 5.823, 7.185, 9.234, all P < 0.05). In addition, the numbers of patients with grade I, II and III severe traumatic brain injury in the observation group were significantly lower than those in the control group (all P < 0.05). The number of patients with grade V prognosis in the observation group was significantly higher than that in the control group [20 (58.8%) vs. 8 (23.5%), χ2 = 8.743, P < 0.05]. After treatment, severe traumatic brain injury was mitigated in the two groups. National Institute of Health Stroke Scale score in the observation group was significantly lower than that in the control group, and the activity of daily living in the observation group was significantly higher than that in the control group. The numbers of patients with delayed hematoma, a need for reoperation, hydrocephalus, acute encephalocele, epilepsy, and intracranial infection in the observation group were significantly lower than those in the control group. Conclusion:Craniotomy with hematoma evacuation combined with decompressive craniectomy for treatment of severe traumatic brain injury can greatly decrease intracranial pressure, reduce the degree of injury and improve prognosis.
