【摘要】 目的探讨颅脑损伤开颅减压,采用带蒂颞深筋膜与帽状腱膜下组织修补硬脑膜的可行性及实用价值。方法我院收治的颅脑损伤手术患者46例,病灶主要位于额颞部或交界处,采用冠状切口、扩大翼点入路或标准大骨瓣减压入路,进行去骨瓣减压、血肿清除或内减压手术,硬脑膜用带蒂颞深筋膜与帽状腱膜下组织进行修补。结果出现脑脊液漏合并切口感染1例(2.2%),皮下积液4例(8.7%),死亡3例(6.5%),生存43例。生存者均得到1—6月随访,恢复良好,并有一部分来院行颅骨修补手术,再次手术和病理证实:颞深筋膜与帽状腱膜下组织无变性、坏死等改变,与硬脑膜愈合良好。结论颞深筋膜与帽状腱膜下组织是自体同部位组织,与硬脑膜组织结构相同,有足够大的面积和较好的血运。用带蒂颞深筋膜与帽状腱膜下组织修补硬脑膜,恢复了头皮的基本结构层次,充分缓解颅内高压和维持颅内环境稳定;其为颅骨修补提供良好的组织解剖基础,也缩短下次手术时间,减少医疗成本和患者经济负担。采用本术式治疗颅脑损伤,可行、实用,并发症少,对患者损伤小,没有潜在的危害。更多还原

【Abstract】 Objective To discuss the feasibility and practical value of mending the dura mater with the subgaleal tissues and deep temporal fascia with pedicle in the decompression craniotomy operations. Methods 46 clinical cases were the patients in our hospital who had cranial trauma to have operation. The lesions were located on frontal, temporal and junctional areas. The coronal incision, enlarged pterion and standard large cranial flap approach were adopted to decompress by removing cranial flap, hematoma or cerebral tissues. The dura mater was mended by the deep temporal fascia with pedicle and subgaleal tissues. Results 1 case(2.2%) suffered from postoperational cerebral spinal fluid leakage and incision infection. Subcutaneous hydrops occurred in 4 cases(8.7%), 3 cases died and 43 live . The live all were followed up in 1 to 6 months and all recovered well. Some of them came back to mend the skull defect. The second operation and pathology certif icated that the grafted deep temporal fascia and subgaleal tissues presented no degeneration or necrosis, and good reunion with the dura mater. Conclusion The deep temporal fascia and subgaleal tissues are the autologous tissues whose structures are similar to the dura mater. They have enough area and blood supply. That the dura mater is mended by use of the subgaleal tissues and deep temporal fascia with pedicle can restore the basic structure of scalp, relieve the intracranial hypertension effectively, maintain the stability of internal environment, provide good anatomical structure to skull mending, shorten the second operation duration, decrease the medical cost and the patient’s burden. It is a feasible, practicable, less complication, less injury, no latent harm operation method.更多还原