传统骨瓣开颅与小骨窗开颅微创治疗高血压脑出血患者的疗效分析

Comparative analysis of small bone window craniotomy and conventional bone flap craniotomy with hypertension cerebral hemorrhage

目的探讨传统骨瓣开颅与小骨窗微创手术治疗高血压脑出血患者的临床效果并对比分析。方法选择高密市人民医院神经外二科自2016年5月至2018年3月收治的高血压脑出血患者72例,根据患者自身病情及家属意见进行手术分组,40例行小骨窗微创开颅(骨窗组),32例行传统骨瓣开颅减压组(骨瓣组)。对比2组患者的术中手术时间、出血量、住院时间及术后6、24、72 h和1周的颅内压值,并于3个月后随访进行日常生活能力(ADL)评分。结果骨窗组相对于骨瓣组术中出血量少、手术时间短;2组术后6、24 h颅内压力值比较,差异无统计学意义(P>0.05);骨窗组72 h、1周颅内压力值高于骨瓣组,差异具有统计学意义(P<0.05),但经脱水或释放部分脑脊液后,颅内压值均可控制在正常范围之内。术后3个月按照ADL评分:骨窗组Ⅰ~Ⅲ级良好率85.0%,骨瓣组Ⅰ~Ⅲ级良好率62.50%,差异具有统计学意义(P<0.05)。结论与传统骨瓣开颅术相比,小骨窗微创术医源性创伤小,近期预后好,临床效果显著。

Objective To explore and compare the clinical efficacy of small bone window craniotomy with conventional bone flap craniotomy in the treatment of patients with hypertensive cerebral hemorrhage. Methods Seventy two cases of hypertensive cerebral hemorrhage patients treated in the Department of Neurosurgery , Gaomi People＇s Hospital from May 2016 to March 2018 were involved in this study. According to random number table method, all of patients were divided into two groups. Forty cases who were performed small bone window craniotomy treatment through lateral fissure approach as bone window group, 32 cases who were performed traditional bone flap craniotomy treatment as bone flap group. Operation time, intraoperative blood transfusion volume, intraeranial pressure at 6, 24, 72 h and 1 week after operation were compared between the two groups, and the ADL score was evaluated after 3 months tbllow-up. Results Operation time, intraoperative blood transfusion volume in bone window group were signifcantly better than the bone flap group.there were no statistical significances on intracranial pressm＇e at 6, 24 h after operation between the two groups, but there was diflerence at 72 h, 1 week after operation, the intracranial pressure in bone window group was higher than that in the bone flap group. After dehydration or release of part of cerebrospinal fluid, intracranial pressure can be controlled within normal range 33 cases （85.0%） recovered well in observation group, which was better than control group （22 cases, 68.7%）, there was statistical diflerence （P〈0.05）. Conclusion Compared with conventional bone flap craniotomy surgery in the treatment of hypertensive cerebral hemorrhage patients, small bone window craniotomy has the characters of evident clinical eflect, safe and reliable, and has important clinical value.