Clinical study on the curative effect of bilateral bone flap decompressive craniectomy in treating contrecoup injury of the brain

ZHU Luojiang; FANG Lichen; ZENG Yuchun; WU Xiaofang; WANG Wei; TANG Wanli; LIU yu; YUAN Hui

Abstract：Objective Exploring therapeutic effect of bilateral bone flap decompressive craniectomy compared with unilateral decompressive craniectomy in the treatment of brain contralateral injury.Methods A total of 80 patients with contrecoup craniocerebral injury in our hospital admitted from October 1,2016 to October 31,2018 were selected and then included in the study.Patients were divided into control group(40 cases)and observation group(40 cases)by the method using the table of random number.Unilateral bone flap decompression craniotomy was performed in the control group while bilateral bone flap decompression craniotomy was implemented in the observation group.Furthermore,clinical efficacy,complications,intracranial pressure,brain oxygen uptake and cerebral blood flow indexes between above-mentioned two groups were put into comparasion.Results The total clinical effective rate of the observation group was higher than that of the control group(P＜0.05),and incidence rate of complications was the opposite(P＜0.05).There was no difference in preoperative intracranial pressure and brain oxygen uptake between the observation group and the control group.Besides,there was also no distinction between two groups in cerebral blood flow indicators,including preoperative peak systolic flow velocity in the middle cerebral artery,average blood flow velocity and pulsatility index.Compared with control group,the peak systolic flow velocity in the middle cerebral artery,average blood flow velocity and the rate of cerebral oxygen uptake of the observation group significantly increased(P＜0.05,P＜0.01),while intracranial pressure and pulsatility index apparently decreased(P＜0.0l).In contrast to control group,GCS scores of observation group two weeks after surgery indicated significant improvement(P＜0.05).Six months after surgery,GOS score suggested that the overall good prognosis rate of the observation group was better than that of the control group(P＜0.05).Conclusion Compared with unilateral bone flap decompressive craniectomy,bilateral bone flap decompressive craniectomy demonstrated better clinical effect in treating contralateral brain injury in view of its high security,which deserved promotion.