双骨窗开颅术治疗骑跨上矢状窦硬膜外血肿的临床研究

Clinical study on the treatment of epidural hematoma straddling superior sagittal sinus with double bone flap craniotomy

目的探讨骑跨上矢状窦硬膜外血肿的手术治疗的方法及预后。方法选择自2000~2013年间在绍兴市中心医院神经外科收治的45例骑跨上矢状窦硬膜外血肿病例的临床资料、手术方式及预后进行回顾性分析。其中23例患者采用上矢状窦旁的单骨窗开颅,窦旁硬脑膜悬吊加明胶海绵填塞止血,22例进行了上矢状窦旁的双骨窗开颅,矢状窦上保留骨桥后硬脑膜悬吊止血。结果上矢状窦旁的单骨窗开颅组,恢复良好10例,轻度残疾4例,重度残疾4例,植物生存2例,死亡3例。上矢状窦旁的双骨窗开颅组恢复良好15例,轻度残疾5例,重度残疾1例,植物生存0例,死亡1例。两组的治疗效果双骨窗组好于单骨窗组,差异有统计学意义（Z=21.798,P=0.031）结论骑跨上矢状窦的硬膜外血肿掌握好合适的手术适应证、手术方式,可获得满意的疗效。上矢状窦旁的双骨窗开颅可明显提高手术效果。

Objective To study the method and prognosis of operation in straddle superior sagittal sinus epidural hematoma. Methods The clinical data, operation methods and prognosis of 45 cases of straddle superior sagittal sinus epidural hematoma were analyzed retrospectively. Among 23 patients with parasagittal single bone flap craniotomy, sinus dural suspension and gelatin sponge packing hemostasis, 22 cases were double bone flap craniotomy parasagittal dural suspension, hemostatic intact bridge after the sagittal sinus. Results Single bone flap craniotomy group parasagittal, good recovery in 10 case, mild disability in 4 case, severe disability in 4 case, plant survival of 2 case, 3 case of death. Parasagittal double bone flap craniotomy group, 15 case of good recovery, 5 case of mild disability, severe disability in 1 case, plant survival of 0 case, 1 case of death. The group of double bone flap craniotomy is better effect than single bone flap group. The difference was statistically significant （Z= 21.798, P=0.031） Conclusion Straddle superior sagittal sinus epidural hematoma in mastering the appropriate operation indication, operation method, can obtain satisfactory result. Double bone flap craniotomy parasagittal can significantly improve the operation effect.