小骨窗及常规骨瓣清除硬膜外血肿的前瞻性随机对照研究

Prospective randomized controlled study on small-window craniotomy versus ordinary large-window craniotomy in the evacuation of epidural hematoma

共95例急性硬膜外血肿并早期脑疝形成患者随机行小骨窗(44例)或常规去骨瓣(51例)血肿清除术。结果显示,小骨窗组患者手术时间短(P=0.000),术中出血量(P=0.000)和输血量(P=0.031)少;而两组术后残留血肿量(P=0.141)、清醒时间(P=0.201)、大面积脑缺血(P=0.865)和脑水肿(P=0.879)发生率,以及术后6个月时Glasgow预后分级(P=0.603)差异均无统计学意义。表明小骨窗血肿清除术可有效清除血肿并解除脑疝,其手术效果及预后与常规去骨瓣减压血肿清除术无明显差异,且具有手术时间短、术中出血量和输血量显著减少等优点。

There is still controversy on the clinical efficacy of small-window eraniotomy （SWCT） for acute epidural hematoma with concurrent early-phase cerebral herniation. This study compared multiple surgical and prognostic parameters of SWCT versus ordinary large-window craniotomy （LWCT）, which aimed at providing evidences for surgical decision. Compared with LWCT （N = 51）, SWCT （N = 44） displayed shortened average operation time （P = 0.000）, reduced intraoperative blood loss （P = 0.000） and lessened intraoperative blood transfusion （P = 0.031）. Moreover, there was no differences of postoperative residual hematoma （P = 0.141）, postoperative palinesthesia time （P = 0.201）, the ratio of postoperative secondary isehemia （P = 0.865） or cerebral edema （P = 0.879）, and 6-month Glasgow Outcome Scale （GOS） score （P = 0.603） between the two surgical approaches. Results suggested that, for patients with acute epidural hematoma and concurrent early-phase cerebral herniation, SWCT could effectively evacuate hematoma and relief brain herniation without significant differences of effect and prognosis from LWCT. In addition, SWCT has several advantages such as significantly reduced operation time, intraoperative blood loss and blood transfusion.