| Objective To observe the clinical effect of step decompression strategy to remove bone flap decompression in severe traumatic brain injury, and to analyze the influencing factors of intraoperative acute encephalocele. Methods 103 patients with severe traumatic brain injury treated in our hospital from January 2020 to August 2021 were retrospectively selected. According to the different operation methods, the patients were divided into group A (conventional bone flap decompression, n = 50) and group B (step decompression strategy, bone flap decompression, n = 53). The operation related indexes, the incidence of complications and the prognosis of the two groups were compared. In addition, according to whether there was acute encephalocele during craniotomy, the patients were divided into bulge group (n = 41) and non bulge group (n = 62). Multivariate logistic regression was used to analyze the influencing factors of intraoperative acute encephalocele in patients with severe traumatic brain injury. Results The operation time of group B was shorter than that of group A, the amount of intraoperative bleeding was less than that of group A, and the incidence of acute encephalocele and delayed intracranial hematoma was lower than that of group A (P < 0.05). The good prognosis rate of group B was higher than that of group A (P < 0.05). Univariate analysis showed that intraoperative acute encephalocele in patients with severe traumatic brain injury was related to age, time from injury to operation, DTIH, contralateral skull fracture, first GCS score after admission, PADBS, history of hypertension, preoperative body temperature, preoperative intracranial pressure, PLT and Pt (P < 0.05). Multivariate logistic regression analysis showed that combined with contralateral skull fracture, DTIH, PADBS, injury to operation time < 3h, first GCS score < 6 after admission, high preoperative intracranial pressure and high preoperative temperature were the risk factors of intraoperative acute encephalocele in patients with severe traumatic brain injury (P < 0.05), while the step decompression strategy of bone flap decompression was the protective factor (P < 0.05). Conclusion Using step decompression strategy to remove bone flap decompression in the treatment of severe traumatic brain injury can reduce the amount of intraoperative bleeding, shorten the operation time, reduce the incidence of complications and improve the prognosis of patients. Whether intraoperative acute encephalocele in patients with severe traumatic brain injury is affected by combined with contralateral skull fracture, DTIH, PADBS, time from injury to operation, first GCS score after admission, preoperative body temperature, preoperative intracranial pressure and other factors. |
