目的 总结重型颅脑损伤去骨瓣减压术中对侧迟发性血肿的手术经验.方法 回顾分析2011年1月～2018年10月收治的47例重型颅脑损伤的临床资料,去骨瓣减压术中出现急性脑膨出,CT发现对侧颅内血肿35例(CT组),术中超声发现对侧颅内血肿12例(超声组).结果 超声组手术时间[(4.98±0.60)h]较CT组[(7.11±1.54)h]明显缩短(P＜0.01).术后6个月,CT组GOS评分4～5分7例,3分6例,2分5例,1分17例;超声组GOS评分4～5分5例,3分3例,2分2例,1分2例.两组预后无统计学差异(P＞0.05).结论 CT、术中超声能及时准确发现颅内血肿,指导手术,但术中超声能缩短手术时间.

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.

Objective To investigate the risk factors associated with post traumatic cerebral infarction (PTCI) after craniotomy hematoma evacuation for severe traumatic brain injury (sTBI) so as to provide clinical reference for the early prevention of postoperative PTCI.Methods A retrospective case control study was conducted to analyze the clinical data of 558 sTBI patients who received craniotomy hematoma evacuation admitted to Changsha Hospital of Traditional Chinese Medicine from October 2006 to June 2016.There were 340 males and 218 females,aged 15-71 years,with an average of 47.8 years.Among them,75 patients were at the age of less than 30 years,315 were at 30-50 years,and 168 were above 50 years.According to the Glasgow coma score (GCS),there were 127 patients with 3-4 points,124 with 5-6 points,and 307 with 7-8 points.The patients were divided into PTCI group (51 patients)and non-PTCI group (507 patients).The related indicators of the two groups of patients after admission were collected,including gender,age,injury cause,GCS,skull base fracture,traumatic subarachnoid hemorrhage (tSAH),cerebral hernia,hypotension,the time from injury to craniotomy,and whether decompressive craniectomy was performed.Univariate analysis was first performed for these factors,followed by multivariate logistic regression analysis.Results There were no significant differences in gender,age,injury cause,skull base fracture,and decompressive craniectomy between PTCI group and control group (P ＞ 0.05).In the PTCI group,there were 29 patients with GCS of 3-4 points,17 with 5-6 points,and five with 7-8 points;there were 48 patients with tSAH,37 patients with cerebral hernia,and 18 patients with hypotension.In terms of the time from injury to craniotomy,it took ＜ 3 hours in 30 patients,3-6 hours in 12,6-12 hours in five,and ＞ 12 hours in four.In the non-PTCI group,there were 98 patients with GCS of 3-4 points,107 with 5-6 points,and 302 with 7-8 points.There were 34 patients with tSAH,117 with cerebral hernia,and 35 with hypotension.In terms of the time from injury to craniotomy,it took ＜3 hours in 294 patients,3-6 hours in 130,6-12 hours in 68,and ＞ 12 hours in 15.The differences between the two groups were statistically significant (P ＜ 0.05).Multivariate logistic regression analysis indicated that GCS of 3-6 points,tSAH,cerebral hernia,time from injury to craniotomy,and hypotension were significantly associated with PTCI after operation for sTBI (P ＜ 0.01).Conclusions GCS of 3-6 points,tSAH,cerebral hernia,duration from injury to craniotomy,and hypotension time ＞ 3 hours are the high risk factors of PTCI in sTBI patients after craniotomy.For patients with these high risk factors,craniotomy should be performed in time,and the perioperative blood pressure and intracranial pressure stability should be maintained so as to relieve vasospasm.

目的 总结外伤性脑内血肿开颅清除术后术区再出血二次手术处理体会.方法 回顾性分析2006年10月至2016年2月收治的23例外伤性脑内血肿开颅清除术后术区再出血二次手术的临床资料.结果 根据GOS评分:11例恢复良好,6例重残,5例植物生存,2例死亡.再二次手术中未发生恶性脑膨出,第三次出血1例.结论 外伤性脑内血肿开颅清除术后术区再出血二次手术需采取正确的处理方法 ,避免术中恶性脑膨出,减少再出血机会,以提高生存率.

目的探讨脑室-腹腔分流与颅骨修补同期手术治疗颅脑外伤术后颅脑缺损并发脑积水的临床疗效。方法选取我院在2012年6月~2014年12月收治的68例颅脑外伤术后颅骨缺损并发脑积水患者作为研究对象，使用随机数字表法分为观察组和对照组（各34例），对照组患者先行脑室腹腔分流术，后行颅骨修补术，观察组同期行脑室-腹腔分流术和颅骨修补术，比较两组患者的治疗效果。结果观察组患者的治愈率、显效率及总有效率均显著高于对照组，<0.05。观察组术后并发症发生率为2.94%，对照组为14.71%，组间比较，差异具有统计学意义（<0.05）。并发症类型包括感染、分流过度、脑脊液漏、硬膜下血肿积液。结论脑室-腹腔分流与颅骨修补同期手术治疗颅脑外伤术后颅骨缺损伴脑积水的临床疗效显著，同时还能降低术后并发症发生率，临床应用价值显著，值得推广。

Objective To study the risk factors related with progressive hemorrhagic injury (PHI)after severe head injury for a view to early diagnosis and treatment for this disease and providing a basis for effective prevention. Methods In a retrospective study of 262 patients with severe brain injury in considering the clinical data of the PHI, the occurrence is variable, and age, gender, bleeding site, type of bleeding, dilated pupils starus, level of systolic blood pressure on admission, time of CT for the first time,GOS scores, injured mechanism, interval between first and second time CT, application of high-dose mannitol, platelet (PLT) count, prothrombin time (PT), activated partial prothrombin time (APTT) were considered as independent variables. Results The incidence rate of having PHI was 47.7% (125/262);single-factor analysis revealed that, as compared with those in patients with non-PHI, 7 factors in patients with PHI were significantly different, namely, age, type of hemorrhage, interval between injury and first-time CT, GCS scores, PLT count, PT and APTT. Multivariate logistic regression analysis of the results showed that interval between injury and first-time CT, GCS scores, PLT count were the risk factors of having PHI, and their OR values were 3.5448, 3.2975 and 2.2361, respectively. Conclusion For patients with severe brain injury, the sooner the first time CT examination is performed, the lower the GCS scores are and the lower the PLT count is, the higher risk of having PHI is. Thus, dynamic CT formal review is suggested to improve the early diagnosis and treatment of PHI.

[目的]研究超早期显微手术?疗高血?脑出血?疗效.方法]T顾分析?早期经>微手术理的37例高血?脑出血(出血量G于30mL)?临床特1及愈后[结果]本组共生存33例,其中ADL1 10例,ADL2 12例,ADL3 7例,ADL4 4例,无植物生存,死亡4例,总病亡率为10.81%.[结论]对高血压脑出血(出血量大于30ml)患者应尽量争取超早期实施开颅显微手术清除血肿、去骨瓣减压.

目的探讨额窦骨折的影像诊断、分型及治疗措施。方法回顾性分析我院2006年9月～2008年9月收治的18例额窦骨折病例的临床资料和影像资料,总结诊断及手术治疗经验。结果手术组死亡2例,均死于重度颅脑损伤。手术组术后早期出现脑脊液鼻漏6例,经预防感染等对症处理后于2周内停止。手术组额部无明显畸形,无其他并发症。非手术组出现脑脊液鼻漏1例,药物治疗后恢复良好,无明显额部畸形。结论CT可明确诊断,根据CT分型决定治疗措施,除前壁闭合性单纯线性骨折外,其它各型均宜积极手术探查,术中彻底清创,一期修补颅底及颅骨缺损,可提高治愈率,减少并发症。

目的探讨弥漫性轴索损伤(DAI)发病机制、临床特点、诊断及治疗。方法回顾性分析56例DAI病人的临床资料。结果按GOS评分结果:治愈17例(30%),中残15例(16%),重残或植物生存16例(28%),死亡8例(16%)。结论弥漫性轴索损伤(DAI)的诊断要结合临床表现和动态影像学检查,CT扫描正常不能完全排除DAI,GCS评分、昏迷时间、瞳孔变化、出血灶部位是判断预后的重要指标,早期正确诊断和有效综合治疗是改善病人预后的关键。