微骨窗开颅治疗小脑出血的疗效分析

Clinical effect of micro-bone window craniotomy in treatment of cerebellar hemorrhage

目的探讨微骨窗开颅术在小脑出血患者中的临床疗效及对术后认知功能和日常生活能力的影响。方法回顾性分析2012年8月至2018年6月在我科行手术治疗的51例小脑出血患者的临床资料,其格拉斯哥昏迷评分(GCS)在9～12分,根据手术方案不同分为传统开颅手术组(n=26例)和微骨窗开颅手术组(n=25例)。并对两组的手术时间、术中出血量、术后头皮下引流管留置时间、住院时间以及术后1个月、2个月及3个月的简易精神状态检查(MMSE)评分和巴氏指数(BI)评分进行统计学分析。结果微骨窗开颅手术组在手术时间、术中出血量、术后头皮下引流管留置时间及住院时间等方面均优于传统开颅手术组(P <0. 05);微骨窗开颅手术组手术后1个月、2个月及3个月MMSE评分和BI评分与传统开颅手术组相比无显著性差异(P> 0. 05)。结论微骨窗开颅手术用于治疗GCS评分9～12分小脑出血患者具有手术时间短,术中出血量少,住院时间短等优点,在术后认知功能和日常生活能力恢复方面与传统开颅手术相比无明显差异。

Objective To investigate the clinical effect of micro-bone window craniotomy in the treatment of patients with cerebellar hemorrhage and its effect on cognitive function and activities of daily living( ADL) after surgery. Methods A retrospective analysis was performed for the clinical data of 51 patients with cerebellar hemorrhage who underwent surgical treatment in our department from August 2012 to June 2018,and their Glasgow Coma Scale( GCS) score ranged from 9 to 12 points. According to the surgical plan,the patients were divided into traditional craniotomy group with 26 patients and micro-bone window craniotomy group with 25 patients. The two groups were compared in terms of time of operation,intraoperative blood loss,time of postoperative drainage under the scalp,and length of hospital stay,as well as Mini-Mental State Examination( MMSE) score and Barthel Index( BI) at 1,2,and 3 months after surgery. Results Compared with the traditional craniotomy group,the micro-bone window craniotomy group had significantly better time of operation,intraoperative blood loss,time of postoperative drainage under the scalp,and length of hospital stay( P < 0. 05).There were no significant differences in MMSE score and BI at 1,2,and 3 months after surgery between the two groups( P > 0. 05).Conclusions In patients with cerebellar hemorrhage and a GCS score of 9-12 points,micro-bone window craniotomy has the advantages of a short time of operation,low intraoperative blood loss,and a short length of hospital stay. However,there is no significant difference between traditional craniotomy and micro-bone window craniotomy in the recovery of cognitive function and ADL after surgery.