微创钻孔密闭引流手术治疗慢性硬膜下血肿临床疗效观察

Clinical efficacy of closed drainage via minimally invasive drilling for chronic subdural hematoma

目的探讨观察微创钻孔密闭引流技术在慢性硬膜下血肿治疗中的应用价值。方法按入选标准及课题研究方案选取124例CSDH患者,随机分为A组(单孔钻孔引流)和B组(双孔钻孔密闭引流),分别统计分析两组手术、拔管、留院时间,气颅、血肿复发率、神经康复等指标。结果⑴与B组相比,A组的患者在手术时间、住院时间相比明显少(P<0.01);⑵与B组相比,A组的患者气颅发生率较少(P<0.05),两组在血肿复发率无统计学差异(P>0.05)。⑶与B组相比,A组患者神经康复指标BI和GOS较低(P<0.01)。结论⑴微创钻孔密闭引流术(单、双孔)是治疗CSDH的行之有效的方法,⑵单孔密闭引流术在手术及留院时间、气颅发生率方面具有优势,而在3个月神经康复方面双孔引流较好。

Objective To evaluate the role of closed drainage via minimally invasive drilling in the treatment of chronic subdural cere- bral hematoma. Methods One hundred and twenty-four patients with chronic subdural cerebral hematoma who were enrolled after meeting inclusion criteria were randomly divided into group A （drainage with a single burr hole） and group B （drainage with two burr holes）. Outcome measures including operative time, time to extubation, length of hospital stay, rate of pneumocrania, recurrence rate of hematoma, Barthel Index （BI）, and Glasgow Outcome Scale （GOS） score were compared between the two groups. Results Group A had significantly shorter operative time and length of hospital stay than group B （P 〈0. 01 ）. Pneumocrania occurred less frequently in group A than in group B （P 〈 0. 05）, and the recurrence rate of hematoma was not statistically significant between the two groups （ P 〉 0.05）. The BI and GOS score were significantly lower in group A than in group B （P 〈 0.01 ）. Conclusions Closed drainage via minimally invasive drilling （ single or two burr holes） is an effective procedure for the treatment of chronic subdural cerebral hema- toma. Closed drainage with a single burr hole is superior to closed drainage with double burr holes in terms of operative time, length of hospital stay, and rate of pneumocrania, whereas closed drainage with double burr holes offer greater benefits in neurological rehabilita- tion at the three-month follow-up.