CAJ | 학술논문

背景：重型颅脑损伤开颅手术需要保持硬脑膜的完整性，人工硬脑膜是目前常见的硬脑膜修补材料，寻找理想的人工硬脑膜是神经外科探索的方向。 　　目的：探讨胶原海绵人工硬脑膜修补重型颅脑损伤的效果。 　　方法：回顾性分析96例重型颅脑损伤患者的临床资料，其中64例采用胶原海绵人工硬脑膜在不缝合情况下修补硬脑膜缺损，32例采用常规硬脑膜在严密缝合下修补硬脑膜缺损。观察两组开颅血肿清除手术时间、出血量及术后机械通气时间、ICU 监护时间、总的住院天数；开颅血肿清除到颅骨修补的时间间隔、颅骨修补手术时间及出血量、硬脑膜破损及修补后6个月格拉斯哥昏迷评分。 　　结果与结论：两组均能达到减压目的。两组之间开颅血肿清除手术出血量、术后机械通气时间、ICU 监护时间、总的住院天数、硬脑膜修补后6个月格拉斯哥昏迷评分比较差异无显著性意义(P >0.05)；胶原海绵人工硬脑膜组开颅血肿清除手术时间、颅骨修补硬脑膜破损、颅骨修补手术时间及出血量低于常规硬脑膜组(P <0.05)。表明胶原海绵人工硬脑膜在重型颅脑损伤中在充分发挥减压作用，维持脑功能，缩短手术时间的优势上，能达到和严密缝合硬脑膜同样的效果，为后期颅骨修补创造有利条件。
배경：중형로뇌손상개로수술수요보지경뇌막적완정성，인공경뇌막시목전상견적경뇌막수보재료，심조이상적인공경뇌막시신경외과탐색적방향。 　　목적：탐토효원해면인공경뇌막수보중형로뇌손상적효과。 　　방법：회고성분석96례중형로뇌손상환자적림상자료，기중64례채용효원해면인공경뇌막재불봉합정황하수보경뇌막결손，32례채용상규경뇌막재엄밀봉합하수보경뇌막결손。관찰량조개로혈종청제수술시간、출혈량급술후궤계통기시간、ICU 감호시간、총적주원천수；개로혈종청제도로골수보적시간간격、로골수보수술시간급출혈량、경뇌막파손급수보후6개월격랍사가혼미평분。 　　결과여결론：량조균능체도감압목적。량조지간개로혈종청제수술출혈량、술후궤계통기시간、ICU 감호시간、총적주원천수、경뇌막수보후6개월격랍사가혼미평분비교차이무현저성의의(P >0.05)；효원해면인공경뇌막조개로혈종청제수술시간、로골수보경뇌막파손、로골수보수술시간급출혈량저우상규경뇌막조(P <0.05)。표명효원해면인공경뇌막재중형로뇌손상중재충분발휘감압작용，유지뇌공능，축단수술시간적우세상，능체도화엄밀봉합경뇌막동양적효과，위후기로골수보창조유리조건。
BACKGROUND:Craniotomy for severe traumatic brain injury is required to maintain the integrity of the dura mater. The artificial dura mater is now a common dural repair material, and looking for the ideal artificial dura mater is the exploring direction of neurosurgery. OBJECTIVE:To explore the application of colagen sponge artificial dura in severe traumatic brain injury METHODS:A retrospective analysis of 96 patients with severe head injury was performed, including 32 cases of the artificial dura with tightly suturing as the control group, and 64 cases of the artificial dura of colagen sponge without suturing as the experimental group. Operating time for hematoma clearance, blood loss, postoperative mechanical ventilation time, ICU monitoring time, the total number of hospitalized days as wel as time interval from hematoma clearance to cranioplasty, operative time for cranioplasty, blood loss, and Glasgow Coma Scale scores after dural damage and 6 months postoperatively in the two groups were measured. RESULTS AND CONCLUSION:The same purpose was achieved in the two groups. The amount of bleeding during hematoma clearance, postoperative mechanical ventilation time, monitoring time in ICU, the total number of hospitalized days and Glasgow Coma Scale score of 6 months postoperatively showed no significant difference between the two groups (P> 0.05). But operative time for hematoma clearance and cranioplasty as wel as blood loss in the second operation were statisticaly significant between two groups (P< 0.05). The colagen sponge artificial dura in severe traumatic brain injury can fuly play a good role in reducing intracranial pressure, keeping brain functions, shortening operative time, and improving outcomes of patients, which has similar effects to tightly suturing the dura and creates favorable conditions for the folowing cranioplasty.