大骨瓣減壓術治療重型顱腦損傷的系統評價_《中國循證醫學雜志》

作者：

1. 廣西醫科大學第一附屬醫院神經外科（南寧 530021）；2. 四川大學華西醫院神經外科（成都 610041）;

關鍵詞：

重型顱腦損傷去骨瓣減壓術標準外傷大骨瓣減壓術有限骨瓣開顱去骨瓣減壓術系統評價

DOI：

10.7507/1672-2531.20090175

視頻：

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摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的　系統評價標準外傷大骨瓣減壓術與有限骨瓣開顱去骨瓣減壓術治療重型顱腦損傷伴難治性顱內壓增高的療效性和安全性。
方法　按Cochrane 系統評價方法，計算機檢索Cochrane 協作網創傷組數據庫（2008年3 期）、MEDLINE（1966 ～ 2008.10）、EMbase（1984 ～ 2008.10）、中國生物醫學文獻光盤數據庫（1978 ～ 2006.10）、中文期刊全文數據庫（1979 ～ 2008.10），并檢索臨床試驗注冊網站，尋找已發表或未發表的臨床試驗。同時手工檢索相關文獻包括納入文獻的參考文獻、雜志增刊及會議摘要。對納入文獻進行質量評價后，采用RevMan 5.0 軟件進行Meta 分析。
結果　共納入2 個隨機對照試驗，包括716 例患者。Meta 分析結果顯示：① 療效性：標準外傷大骨瓣（STC）組病死率低于有限骨瓣（LC）組［RR=0.74，95%CI （0.61，0.89），P=0.002］；STC 組的有效生存率［RR=1.37，95%CI（1.10，1.72），P=0.006］和存活率［RR=1.20，95%CI（1.02，1.42），P=0.03］均優于LC 組，STC 組病人顱內壓下降速度和程度優于LC 組。② 安全性：兩組病人術后急性腦膨出、術后外傷性癲癇、顱內感染和腦脊液漏的發生率差異均無統計學意義。
結論　治療重型顱腦損傷伴難治性顱內壓增高，STC 能明顯改善患者預后，療效優于LC，但兩組常見術后并發癥發生率差異無統計學意義。雖納入研究質量較高，但數量較少且僅限于國內，因此期待更多高質量大樣本隨機對照試驗來驗證其有效性和安全性。

引用本文： 莫貽敏,秦坤明,楊朝華. 大骨瓣減壓術治療重型顱腦損傷的系統評價. 中國循證醫學雜志, 2009, 09(9): 985-993. doi: 10.7507/1672-2531.20090175 復制

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12.	Schneider GH, Bardt T, Lanksch WR, et al. Decompressive craniectomy following traumatic brain injury brain injury : ICP, CPP and neurological outcome. Acta Neurochir, 2002, 81: 77-82.
13.	Coplin WM, Cullen NK, Policherla PN, et al. Safty and feasibility of craniectomy with duraplasty as the initial surgical intervention for severe traum aticbrain injury. J Trauma, 2001, 50(6): 1050-1059.
14.	Anna Taylor, Warwick Butt, Jeffrey Rosenfeld, et al. A randomized trial of very early decompressive craniectomy in children with traumatic brain injury and sustained intracranial hypertension. Child’s Nerv Syst, 2001, 17: 154-162.
15.	Ruf B, Heckmann M, Schroth I, et al. Early decompressive craniectomy and duraplasty for refractory intracranial hypertension inchildren: results of a pilot study. Critical Care, 2003, 7(61): 133-138.
16.	Coplin WM, Cullen NK, Policherla PN, et al. Saftyand feasibility of craniectomy with duraplasty as the initial surgical intervention for severe traum aticbrain injury. J Trauma, 2001, 50(6): 1050-1059.
17.	Sahuquillo J, Arikan F. Decompressive craniectomy for the treatment of refracrtory high intracranial pressure in traumatic brain injury. Cochrane Database of Systematic Review, 2006, Issue 1.
18.	Maas AIR, Dearden M, Teasdale GM, et al. EBIC-Guidelines for Management of Severe Head Injury in Adults. Acta Neurochir (Wien), 1997, 139: 286-294.
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20.	Howard JL, Cipolle MD, Anderson M, et al. Outcome after decompressive craniectomy for the treatment of severe traumatic brain injury. J Trauma, 2008, 65(2): 380-386.
21.	Becker DP, Gade GF, Young HF, et al. Diagnosis and treatment of head injury in adults: WB Saunders: Philadelphia, 1990. 2017-2148.
22.	DE Luca GP, Volpin L, Fornezza U, et al. The role of decompressive craniectomy in the treatment of uncontrollable post-traumatic intracranial hypertention. Acta Neurochir, 2000, 76(3): 401-404.
23.	Schulz Ch, Lülsdorf P, Klawki P. Limited craniotomy versus primary large decompressive craniectomy for acute traumatic subdural haematoma of the elderly - A retrospective study. Journal fur Neurologie, Neurochirurgie und Psychiatrie, 2005, 6(4): 29-31.
24.	Winter CD, Adamides A, Rosenfeld JV. The role of decompressive craniectomy in the management of traumatic brain injury: a critical review. Journal of Clinical Neuroscience, 2005, 12(6): 619-623.
25.	Münch E, Horn P, Schürer L, et al. Management of severe traumatic brain injury by decompressive craniectomy. Neurosurgery, 2000, 47(2): 315-322.
26.	Alexander E. Management of severe traumatic brain injury by decompressive craniectomy. Neurosurgery, 2001, 48(3): 704.
27.	Jiang JY. An introduction to standard large trauma craniotomy which is often used clinically in USA. Chin J Neurosurg, 1998, 14: 381.
28.	Gu L, Liang W, Xiaofeng Y, et al. Efficacy of large decompressive craniectomy in severe traumatic brain injury. Chinese Journal of Traumatology (English Edition), 2008, 11(4): 253-256.
29.	Qiang H, Weimin D, Taihua W, et al. Comprison of standard large trauma craniotomy with routine craniotomy in treatment of acute subdural hematoma. Chinese Journal of Traumatology(English Edition), 2003, 6(5): 305-308.
30.	Jiang JY, Xu W, Liu WP, et al. Efficacy of Standard Trauma Craniectomy for Refractory Intracranial Hypertension with Severe Traumatic Brain Injury: A Multicenter, Prospective, Randomized Controlled Study. Journal of Neurotrauma, 2005, 22(6): 623-628.
31.	Jiang JY. Recent advance and current status of management of head trauma in trauma in China. Chinese Journal of Traumatology(English Edition), 2008, 11(4): 222-224.
32.	盧洪流. 中英對照GOS評分. 中華神經醫學雜志, 2005, 4(5): 537.
33.	Higgins JPT, Altman DG (editors): Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.0 (updated February 2008). The Cochrane Collaboration, 2008. Available from URL:http://www.cochrane-handbook.org.
34.	吳泰相, 劉關鍵. 隱藏分組（分配隱藏）和盲法的概念、實施與報告. 中國循證醫學雜志, 2007, 7(3): 222-225.
35.	Lu LQ, Jiang JY, Mingkun Y, et al. Standard large trauma craniotomy for severe traumatic brain injury. Chinese Journal of Traumatology (English Edition), 2003, 6(5): 302-304.
36.	Rappaport M, Hall KM, Hopkins K, et al. Disability rating scale for severe head trauma: Coma to community. Arch Phys Med Rehabil, 1982, 63: 118-123.

1. Emedicine Specialties (2009): Traumatic Brain Injury (TBI) - Definition, Epidemiology, Pathophysiology.Available from URL: http:// www.emedicine.com/pmr/TOPIC212.HTM#section~Epidemiology.
2. Niedzwecki CM, Marwitz JH, Ketchum JM, et al. Traumatic brain injury: a comparison of inpatient functional outcomes between children and adults. Head Trauma Rehabil, 2008, 23(4): 209-219.
3. 江基堯, 高立達. 顱腦損傷概論. 見: 王忠誠. 主編. 王忠誠神經外科學. 第5版. 武漢: 湖北科學技術出版社, 2005. 380-381.
4. Langlois JA, Rutland-Brown W, Thomas KE. Traumatic brain injury in the United States: emergency department visits, hospitalizations, and deaths. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2006.
5. Tagliaferri F, Compagnone C, Korsic M, et al. A systematic review of brain injury epidemiology in Europe. Acta Neurochir (Wien), 2006, 148: 255-268.
6. Rosso A, Brazinova A, Janciak I, et al. Severe traumatic brain injury in Austria II: epidemiology of hospital admissions. Wien Klin Wochenschr, 2007, 119: 29-34.
7. Finkelstein E, Corso P, Miller T, et al. The Incidence and Economic Burden of Injuries in the United States. New York: Oxford University Press, 2006.
8. Becker DP, Gade GF, Miller JD, et al. Prognosis after head injury: WB Saunders: Philadephia, 1990. 2194-2229.
9. Thurman D, Alverson C, Dunn K, et al. Traumatic brain injury in the United States: a public health perspective. Journal of Head Trauma Rehabilitation, 1999, 14(6): 602-615.
10. 鄭永日譯. 腦外傷的外科治療. 見: 王任直, 主譯. 尤曼斯神經外科學. 第5版. 北京: 人民衛生出版社, 2009. 4104-4106.
11. 江基堯, 朱誠, 羅其中. 顱腦創傷臨床救治指南. 上海: 第二軍醫大學出版社, 2003. 220-227.
12. Schneider GH, Bardt T, Lanksch WR, et al. Decompressive craniectomy following traumatic brain injury brain injury : ICP, CPP and neurological outcome. Acta Neurochir, 2002, 81: 77-82.
13. Coplin WM, Cullen NK, Policherla PN, et al. Safty and feasibility of craniectomy with duraplasty as the initial surgical intervention for severe traum aticbrain injury. J Trauma, 2001, 50(6): 1050-1059.
14. Anna Taylor, Warwick Butt, Jeffrey Rosenfeld, et al. A randomized trial of very early decompressive craniectomy in children with traumatic brain injury and sustained intracranial hypertension. Child’s Nerv Syst, 2001, 17: 154-162.
15. Ruf B, Heckmann M, Schroth I, et al. Early decompressive craniectomy and duraplasty for refractory intracranial hypertension inchildren: results of a pilot study. Critical Care, 2003, 7(61): 133-138.
16. Coplin WM, Cullen NK, Policherla PN, et al. Saftyand feasibility of craniectomy with duraplasty as the initial surgical intervention for severe traum aticbrain injury. J Trauma, 2001, 50(6): 1050-1059.
17. Sahuquillo J, Arikan F. Decompressive craniectomy for the treatment of refracrtory high intracranial pressure in traumatic brain injury. Cochrane Database of Systematic Review, 2006, Issue 1.
18. Maas AIR, Dearden M, Teasdale GM, et al. EBIC-Guidelines for Management of Severe Head Injury in Adults. Acta Neurochir (Wien), 1997, 139: 286-294.
19. American Association Of Neurological Surgeons. Guidelines for the management of severe head injury. Brain Trauma Foundation, American Association of Neurological Surgeons, Joint Section on Neurotrauma and Critical Care. Neurotrauma, 1996, 13, 639-734.
20. Howard JL, Cipolle MD, Anderson M, et al. Outcome after decompressive craniectomy for the treatment of severe traumatic brain injury. J Trauma, 2008, 65(2): 380-386.
21. Becker DP, Gade GF, Young HF, et al. Diagnosis and treatment of head injury in adults: WB Saunders: Philadelphia, 1990. 2017-2148.
22. DE Luca GP, Volpin L, Fornezza U, et al. The role of decompressive craniectomy in the treatment of uncontrollable post-traumatic intracranial hypertention. Acta Neurochir, 2000, 76(3): 401-404.
23. Schulz Ch, Lülsdorf P, Klawki P. Limited craniotomy versus primary large decompressive craniectomy for acute traumatic subdural haematoma of the elderly - A retrospective study. Journal fur Neurologie, Neurochirurgie und Psychiatrie, 2005, 6(4): 29-31.
24. Winter CD, Adamides A, Rosenfeld JV. The role of decompressive craniectomy in the management of traumatic brain injury: a critical review. Journal of Clinical Neuroscience, 2005, 12(6): 619-623.
25. Münch E, Horn P, Schürer L, et al. Management of severe traumatic brain injury by decompressive craniectomy. Neurosurgery, 2000, 47(2): 315-322.
26. Alexander E. Management of severe traumatic brain injury by decompressive craniectomy. Neurosurgery, 2001, 48(3): 704.
27. Jiang JY. An introduction to standard large trauma craniotomy which is often used clinically in USA. Chin J Neurosurg, 1998, 14: 381.
28. Gu L, Liang W, Xiaofeng Y, et al. Efficacy of large decompressive craniectomy in severe traumatic brain injury. Chinese Journal of Traumatology (English Edition), 2008, 11(4): 253-256.
29. Qiang H, Weimin D, Taihua W, et al. Comprison of standard large trauma craniotomy with routine craniotomy in treatment of acute subdural hematoma. Chinese Journal of Traumatology(English Edition), 2003, 6(5): 305-308.
30. Jiang JY, Xu W, Liu WP, et al. Efficacy of Standard Trauma Craniectomy for Refractory Intracranial Hypertension with Severe Traumatic Brain Injury: A Multicenter, Prospective, Randomized Controlled Study. Journal of Neurotrauma, 2005, 22(6): 623-628.
31. Jiang JY. Recent advance and current status of management of head trauma in trauma in China. Chinese Journal of Traumatology(English Edition), 2008, 11(4): 222-224.
32. 盧洪流. 中英對照GOS評分. 中華神經醫學雜志, 2005, 4(5): 537.
33. Higgins JPT, Altman DG (editors): Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.0 (updated February 2008). The Cochrane Collaboration, 2008. Available from URL:http://www.cochrane-handbook.org.
34. 吳泰相, 劉關鍵. 隱藏分組（分配隱藏）和盲法的概念、實施與報告. 中國循證醫學雜志, 2007, 7(3): 222-225.
35. Lu LQ, Jiang JY, Mingkun Y, et al. Standard large trauma craniotomy for severe traumatic brain injury. Chinese Journal of Traumatology (English Edition), 2003, 6(5): 302-304.
36. Rappaport M, Hall KM, Hopkins K, et al. Disability rating scale for severe head trauma: Coma to community. Arch Phys Med Rehabil, 1982, 63: 118-123.

《中國循證醫學雜志》

大骨瓣減壓術治療重型顱腦損傷的系統評價

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《中國循證醫學雜志》

大骨瓣減壓術治療重型顱腦損傷的系統評價

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