探讨256例重型、特重型颅脑外伤（TBI）患者行大骨瓣减压的远期治疗效果。

单中心回顾性队列研究纳入自2012年7月至2016年12月济南军区总医院神经外科收治256例的因重型、特重型TBI急诊行大骨瓣减压的患者，其中重型（GCS评分6~8分）166例、特重型（GCS评分3~5分）90例，采用标准大骨瓣开颅术，减压窗面积约为12 cm×15 cm左右。术后随访18个月，预后分为良好恢复、中残、重残、植物状态、死亡；其中，良好恢复、中度病残为预后良好者，严重病残和植物状态为预后较差者。

恢复良好/中残患者104例（40.61%），但其规范评估行为、心理表现与心理健康的负担未纳入此次临床评估。重残54例、植物状态38例、死亡60例，共计152例患者预后较差（59.37%），可判断59.37%的患者存在预后不良。

标准外伤大骨瓣减压术是治疗重型TBI脑疝形成的有效方法。发生重型、特重型TBI的患者其临床预后差，表现为死亡、植物生存、功能损伤，需要医学界探索新的治疗策略。

Retrospective analysis of 256 cases of severe traumatic brain injury decompressive craniectomy (DC) were long-term clinical curative effect.

A single center retrospective cohort study included from July 2012 to December 2016 in our hospital 256 cases with severe craniocerebral trauma underwent DC in patients with severe (GCS score 6-8) in 166 cases, severe (GCS score 3-5) 90 cases, using standard big bone flap craniotomy decompression open. The window area is about 12 cm×15 cm. After 18 months of follow-up, the prognosis is divided into good recovery, moderate disability, severe disability, vegetative state and death; among them, good recovery, moderate disability for good prognosis, severe disability and poor prognosis for vegetative state.

One hundred and four cases (40.61%) had basic self-care, but the standard evaluation behavior, psychological performance and mental health burden were not included in the clinical evaluation. Forty-eight cases of mild and moderate disability, 44 cases of severe disability, 20 cases of vegetative state, 40 cases of death, a total of 152 patients with poor prognosis (59.37%), 59.37% of the patients can be found to have poor prognosis.

DC is effective for treating severe traumatic brain injury as it could provide complete decompression. The occurrence of severe traumatic brain injury, severe patients with poor clinical prognosis, such as death, plant survival and function damage, the medical profession need to explore new therapeutic strategies.