CAJ | 학술논문

目的探讨多种新诊疗技术或方法对开放性颅脑损伤预后的影响,为规范其临床救治策略提供依据. 方法收集并分析第四军医大学西京医院神经外科自1993年1月至2012年12月收治的852例开放性颅脑损伤患者的致伤原因、临床特点、救治方法及预后,总结开放性颅脑损伤的临床救治经验. 结果 852例患者中男528例,女324例;年龄3～82岁,平均38岁;受伤至入院时间为0.5～62 h,平均3.5 h;住院时间为2 h～72 d,平均11.8 d;致伤原因为锐器伤252例,车祸伤151例,高处坠落伤80例,重物砸伤195例,爆炸伤82例,枪弹伤92例;入院时GCS评分13～15分186例,8～12分367例,8分以下299例;救治后死亡56例,治愈或好转796例;获得随访728例,GOS评分5分者346例,4分者202例,3分者138例,2分者28例,1分者14例.本组患者中采用神经导航取出颅内异物126例,采用真空负压引流+转移皮瓣移植治疗头皮缺失32例,其患者出院时平均GOS评分分别优于未采用神经导航辅助患者、采用常规清创+转移皮瓣移植患者,差异均有统计学意义(P＜0.05). 结论开放性颅脑损伤具有易诊、伤重、难治的特点,其救治应在严格遵循“早期清创、变开放伤为闭合伤”原则的基础上,充分利用神经导航、真空负压引流等各种手术技术,实施个性化治疗,才能有效预防各种并发症发生,显著提高救治水平.
목적 탐토다충신진료기술혹방법대개방성로뇌손상예후적영향,위규범기림상구치책략제공의거. 방법 수집병분석제사군의대학서경의원신경외과자1993년1월지2012년12월수치적852례개방성로뇌손상환자적치상원인、림상특점、구치방법급예후,총결개방성로뇌손상적림상구치경험. 결과 852례환자중남528례,녀324례;년령3～82세,평균38세;수상지입원시간위0.5～62 h,평균3.5 h;주원시간위2 h～72 d,평균11.8 d;치상원인위예기상252례,차화상151례,고처추락상80례,중물잡상195례,폭작상82례,창탄상92례;입원시GCS평분13～15분186례,8～12분367례,8분이하299례;구치후사망56례,치유혹호전796례;획득수방728례,GOS평분5분자346례,4분자202례,3분자138례,2분자28례,1분자14례.본조환자중채용신경도항취출로내이물126례,채용진공부압인류+전이피판이식치료두피결실32례,기환자출원시평균GOS평분분별우우미채용신경도항보조환자、채용상규청창+전이피판이식환자,차이균유통계학의의(P＜0.05). 결론 개방성로뇌손상구유역진、상중、난치적특점,기구치응재엄격준순“조기청창、변개방상위폐합상”원칙적기출상,충분이용신경도항、진공부압인류등각충수술기술,실시개성화치료,재능유효예방각충병발증발생,현저제고구치수평.
Objectives To explore the influence of a variety of new diagnostic techniques or methods in prognosis of patients with open cranio-cerebral injury and to provide the basis for establishing standard treatment strategy for open cranio-cerebral injury.Methods The clinical data,including the causes,clinical characteristics,treatment and prognosis,of 852 patients with open cranio-cerebral injury,admitted to our hospital from January 1993 to December 2012,were analyzed to summarize the clinical treatment experience for open cranio-cerebral injury.Results Of 852 patients,528 were male and 324 were female; the patients aged from 3 to 82 years with an average of 32 years; the duration from injury to hospital ranged from 0.5 h to 62 h,averaging 3.5 h; and the hospital stay lasted from 2 h to 72 d,averaging 11.8 d.According to the injury causes,the patients included 252 of sharp injury,151 of traffic accident injury,80 of high falling injury,195 of heavy fall injury,82 of blast injury,and 92 of bullet wounds.At admission,GCS scores were 13-15 points for 186 patients,8-12 for 367 patients,and below 8 points for 299 patients.Fifty-six patients died after treatment and 796 were cured or improved.Totally,728 got follow-up:GCS scores were 5 points for 346 patients,4 for 202 patients,3 for 138 patients and 2 for 28 patients.Foreign materials were pulled out in 126 patients by neural navigation technique and vacuum-sealed drainage treatment combined with scalp flap transplantation was applied in 32 patients with open cranio-cerebral injury combined with scalp missing.At discharge,the GOS scores of the above two groups were significantly higher than their control groups (P＜0.05).Conclusions Open cranio-cerebral injury is easy to diagnose,but difficult to treat.The treatment should be strictly adhered to the principle of "early debridement,changing open injury to close injury as soon as possible".Furthermore,some kinds of new techniques,such as neural navigation and vacuum-sealed drainage,should be made full use,and the treatment should also be personalized,which can effectively prevent all kinds of complications and significantly improve the treatment.