双额叶脑挫裂伤的治疗策略选择

Selection of treatment strategy for bilateral frontal contusions

摘要:

目的 探讨双额叶脑挫裂伤患者的临床治疗策略。方法 回顾性分析山西医科大学第一医院近10年来收治的59例双额叶脑挫裂伤患者的临床资料，按其伤后水肿高峰期GCS评分将患者分为轻、中和重型，测量各患者水肿高峰期头颅CT中脑挫裂伤灶体积和双侧脑室前夹角，分析各组患者GCS评分与影像学结果的相关性。中、重型患者按其入院后是否行手术治疗，又分为手术治疗组和保守治疗组，比较两组患者在住院时间、并发症发生情况、早、远期预后和远期认知功能等情况。结果 59例双额叶脑挫裂伤患者中轻型20例，中型26例，重型13例，Pearson相关性分析显示各组患者GCS评分与影像学表现呈中度负相关；中、重型组中保守治疗21例，手术治疗18例，保守组仅1例（4.76%）重残，并伴认知功能障碍；手术组3例（16.67%）植物生存，7例（38.89%）重残，12例（66.67%）伴不同程度认知障碍；两组患者在早、远期预后及认知功能方面差异有统计学意义（P<0.05），在并发症及住院时间无统计学差异（P>0.05）。结论 ①双额叶脑挫裂伤患者的GCS评分与其影像学评价指标中度相关，当二者间不完全一致时，治疗策略选择应以GCS评分为准，兼顾影像学改变。②手术治疗组患者总体预后及认知功能差，所以严格把控双额叶脑挫裂伤患者的手术指征，对于保留患者的认知功能、减少不良预后具有重大意义。

Abstract:

Objective To investigate the clinical treatment strategy for patients with bilateral frontal contusions.Methods A retrospective analysis was performed for the clinical data of 59 patients with bilateral frontal contusions who were admitted to The First Hospital of Shanxi Medical University during the past 10 years, and according to the Glasgow Coma Scale (GCS) score at the peak of edema, these patients were divided into mild group, moderate group, and severe group. Head CT scan was performed to measure the volume of contusion lesions and the anterior angle of bilateral ventricles, and the correlation between GCS score and imaging findings was analyzed. According to whether surgical treatment was performed after admission, the patients with moderate and severe contusions were further divided into surgical treatment group and conservative treatment group, and these two groups were compared in terms of length of hospital stay, complications, short- and long-term prognosis, and long-term cognitive function.Results Of all 59 patients with bilateral frontal contusions, 20 had mild contusions, 26 had moderate contusions, and 13 had severe contusions. The Pearson correlation analysis showed that GCS score was moderately negatively correlated with imaging findings. Among the patients in the moderate and severe groups, 21 underwent conservative treatment and 18 underwent surgical treatment; only one patient in the conservative treatment group (4.76%) had severe disability with cognitive impairment, and in the surgical treatment group, 3 (16.67%) survived in a persistent vegetative state, 7 (38.89%) had severe disability, and 12 (66.67%) had varying degrees of cognitive impairment. There were significant differences between the two groups in short- and long-term prognosis and cognitive function (P<0.05), while there were no significant differences in complications and length of hospital stay (P>0.05). Conclusions GCS score is moderately negatively correlated with imaging findings in patients with bilateral frontal contusions. When the two indicators are inconsistent, treatment strategies should be selected based on GCS score, and imaging changes should also be taken into account. Patients in the surgical treatment group tend to have poor prognosis and cognitive function, and therefore, surgical indications should be strictly controlled in patients with bilateral frontal contusions, which is of great significance to maintaining cognitive function and reducing poor prognosis.