常规骨瓣开颅与小骨窗开颅治疗基底核区高血压脑出血的临床疗效比较

Comparison of Conventional Craniotomy and Small Bone Window Craniotomy for the Treatment of Basal Ganglia Cerebral Hemorrhage of Hypertension

目的比较常规骨瓣开颅与小骨窗开颅治疗基底核区高血压脑出血的临床疗效。方法回顾性分析2013年1月至2018年3月滁州市第一人民医院收治的53例基底核区高血压脑出血患者的临床资料,根据不同术式分为对照组(29例)和观察组(24例),对照组用取常规骨瓣开颅治疗,观察组采用小骨窗开颅治疗。比较两组患者的血肿复发率、血肿清除率、手术时间、术中出血量、术后住院时间、不良反应及患者术后3个月的生活能力(ADL量表)。结果观察组血肿复发率、血肿基本清除率均低于对照组[6.9%(2/24)比29.2%(8/29)、45.8%(11/24)比75.9%(22/29)](均P<0.05);观察组手术时间、术后住院时间均短于对照组[(116±16)min比(89±13)min、(31±8)d比(23±4)d],术中出血量少于对照组[(215±25)m L比(87±15)m L](P<0.01);术后3个月,观察组生活能力优于对照组(P<0.05)。结论小骨窗开颅治疗基底核区高血压脑出血的创伤小、术中出血量少,术后血肿复发率低,可有效缩短手术时间和患者住院时间,提高患者术后生活能力。

Objective To compare the efficacy of conventional bone flap craniotomy and small bone window craniotomy in the treatment of basal ganglia intracerebral hemorrhage of hypertension.Methods The clinical data of 53 patients with cerebral hemorrhage of hypertension treated with conventional craniotomy or small bone window craniotomy in Chuzhou First People′s Hospital form Jan.2013 to mar.2018 were retrospectively analyzed.According to different surgical procedures,they were divided into a control group（29 cases） and an observation group（24 cases）,and the control group was treated with conventional bone,while the observation group underwent small bone window craniotomy.The hematoma recurrence rate, hematoma clearance rate,operation time,intraoperative blood loss,postoperative hospital stay,adverse reaction and activity of daily living（ADL） 3 months after surgery were compared between the two groups. Results The recurrence rate and the basic clearance rate of hematoma in the observation group were lower than those in the control group[6.9%（2/24） vs 29.2 %（8/29）,45.8%（11/24） vs 75.9%（22/29）]（ P 〈 0.05 ）.The operation time and postoperative hospital stay in the observation group were shorter than those in the control group[（116±16） min vs （89±13） min,（31±8） d vs （23±4） d],the amount of intraoperative bleeding was less than that of the control group[（215±25） mL vs （87±15） mL] （ P 〈0.01）; 3 months after operation,the living ability of the observation group was better than that of the control group（ P 〈 0.05 ）. Conclusion Small bone window craniotomy for the treatment of hypertensive intracerebral hemorrhage in the basal ganglia is less traumatic with less intraoperative bleeding,lower postoperative recurrence rate of hematoma,and it can effectively shorten the time of operation and the hospitalization time,and improve the living ability after operation.