| purpose:To explore the risk factors related to deterioration during bifrontal contusion and the curative effect of different surgical approach in bifrontal contusion.Clinical data and Methods:Retrospective analysis was applied to patients with bifrontal contusion that hospitalized in Neurosurgery of Jilin University China-Japan Union Hospital during July 2014-December 2016.Selection standard:（1）admitted to hospital within 24 hours after injury and head CT indicated bifrontal contusion;（2）admission GCS score>8 points;（3）no definite emergency operation characteristic when being admitted;exclusion criteria:（1）patients combined with injury in other parts needing operation;（2）patients combined with severe injury in other body parts.（3）Cases without complete data.Applied conservation treatment to all patients and rendered operative treatment if any of the following situations emerged:（1）patients with progressive decline of consciousness disturbance or aggravated after being improved by hypertonic treatment;（2）re-examination CT indicated progressive enlargement of intracranial hematoma or edema,or blocking of bilateral brain ventricles,supra sella cistern,interpeduncular cistern and ambient cistern due to compression;（3）patients with progressive decline of consciousness disturbance,but in severe headache and abnormal dysphoria;（4）intracranial pressure monitoring ICP≥25mmHg constantly.The patients were divided into conservation group and operation group based on whether receiving operation.Single factor analysis was carried out on potential risk factors such as general factors（gender,age,hypertension,and diabetes mellitus）,injury mechanism,GCS score when being admitted by hospital,concurrent injury（subarachnoid hemorrhage,subdural hemorrhage,extradural hemorrhage,and fracture of skull）,anterior angle of bilateral brain ventricles,Marshall CT grading,PaCO2 and blood sodium;the risk factors with statistical significance in single factor analysis were incorporated into Logistic multi-factor regression equation so as to screen out independent risk factors.Followed up visit to all patients for 312 months,evaluated the curative effect with the GOS prognosis score 3 months after injury;score 1 indicated death,23 indicated poor prognosis,45 indicated better prognosis.Evaluated the prognosis of patients in conservation group and operation group;compared the average hospitalization duration and expenses between patients in conservation success group and operation group.Compared the prognosis between patients with unilateral operation and bilateral operation.Results:The complete data of 54 cases were collected.Among the 54 cases,37 patients（68.5%）succeeded in conservation treatment,17 patients（31.5%）received operation treatment after the failure of conservation treatment.Single factor analysis indicated that,anterior angle of bilateral brain ventricles,PaCO2>45mmHg,blood sodium,and Marshall CT grading≥grade III were statistically significant（P < 0.05）.When incorporating the risk factors with statistical significance in single factor analysis were incorporated into Logistic multi-factor regression equation,the result showed that,anterior angle of bilateral brain ventricles>120°,PaCO2>45mmHg and moderate low sodium were the independent risk factors of bifrontal contusion deterioration.The GOS prognosis score 3 months after injury in conservation group: 36 cases were better in 45 points（97.3%）,1 case was poor in 23 points（2.7%）,and 0 case died in 1 point;in operation group,13 cases were in 45 points（76.5%）,3 cases were poor in 23 points（17.6%）and 1 case died in 1 point（5.9%）;7 cases received unilateral admission passage operation,10 cases received bilateral admission passage operation;in unilateral admission passage operation,6 cases were better in 45 points（85.7%）,1 case was poor in 23 points（14.3%）,and 0 case died in 1 point;in bilateral admission passage operation,7 cases were in 45 points（70.0%）,2 cases were poor in 23 points（20.0%）,and 1 case died in 1 point（10.0%）.The prognosis comparison between conservation group and operation group was statistically significant（P<0.05）;the average hospitalization duration of patients in conservation group was 11.0±1.6 days while that in operation group was 16.7±2.1 days,the comparison of two groups was statistically significant（P<0.01）.The average hospitalization expenses of patients in conservation group was 3.3±0.7 ten thousand Yuan while that in operation group was 7.5±1.1 ten thousand Yuan,the comparison of two groups was statistically significant（P < 0.01）.Among patients in operation group,the prognosis comparison between unilateral admission passage operation and bilateral admission passage operation was not statistically significant（P>0.05）.Conclusion:1.Anterior angle of bilateral brain ventricles > 120°,PaCO2>45mmHg and moderate low sodium are the independent risk factors of bifrontal contusion deterioration.The advanced intervention of risk factors may improve patients’ prognosis,shorten hospitalization duration and lower hospitalization expenses.2.Patients with bifrontal contusion shall select individualized opera tion solution such as unilateral or bilateral operative approach according t o imageology characteristics and clinical features. |
