对重型颅脑损伤患者行低位颞部大骨瓣减压术与行标准外伤大骨瓣减压术的疗效比较。

回顾性分析2008年1月至2014年3月武警江西省总队医院神经外科收治的173例重型颅脑损伤患者实行低位颞部大骨瓣减压术（研究组）或标准外伤大骨瓣减压术（对照组）的资料。研究组（92例）行低位颞部去大骨瓣减压术；对照组（81例）行标准外伤大骨瓣减压术。观察2组GOS评分、并发症发生率及预后等指标并进行对比。

术后6个月，按照GOS评分，研究组患者预后良好率（27.2%）、中残率（15.2%）、重残率（29.3%）、植物生存率（8.7%）及病死率（19.6%）与对照组患者预后良好率（22.2%）、中残率（21.0%）、重残率（23.5%）、植物生存率（7.4%）及病死率（25.9%）相比较，差异无统计学意义（P>0.05）；研究组术后并发症平均发生率（8.1%）低于对照组（11.8%），差异具有统计学意义（P<0.05）。

在重型颅脑损伤治疗中，低位颞部大骨瓣减压术可取得与标准外伤大骨瓣减压术相仿的预后，但能有效减少病发症，值得推广。

To compare the efficacy between lower temporal large decompressive craniectomy and standard large trauma craniectomy in the treatment of patients with severe head injury.

The data of 173 patients in Armed Police Jiangxi Corps Hospital from January 2008 to March 2014 with severe head injury, who received lower temporal large decompressive craniectomy(the research group)or standard large trauma craniectomy(the control group), were retrospectively analyzed. Lower temporal large decompressive craniectomy was conducted in the research group(92 cases), while standard large trauma craniectomy was conducted in the control group(81 cases). GCS rating, incidence rate of complications, prognosis and other indicators were observed and compared between two groups.

At 6 months after surgery, no statistically significant differences were reported between these two groups in terms of good recovery, moderate disability, severe disability, vegetative state and dead as defined by GOS rating (27.2%, 15.2%, 29.3%, 8.7% and 19.6% in the research group vs. 22.2%, 21.0%, 23.5%, 7.4% and 25.9% in the control group, respectively) (P>0.05). The average incidence rate of postoperative complications (8.1%) in the research group was lower than that in the control group (11.8%), suggesting a statistically significant difference (P<0.05).

In the treatment of severe head injury, lower temporal large decompressive craniectomy can achieve a comparable prognosis to standard large trauma craniectomy while effectively reduce the complications, demonstrating it is worth clinical promotion.