骨瓣开颅术与小骨窗开颅术治疗高血压脑出血的疗效与安全性比较

Comparison of the efficacy and safety of craniotomy with bone flap and small bone window craniotomy in the treatment of hypertensive intracerebral hemorrhage

目的比较骨瓣开颅术与小骨窗开颅术治疗高血压脑出血的疗效与安全性。方法 80例高血压脑出血患者,按治疗方法差异分为骨瓣开颅术组和小骨窗开颅术组,各40例。骨瓣开颅术组采用骨瓣开颅血肿清除术治疗,小骨窗开颅术组采用小骨窗开颅血肿清除术治疗,比较两组患者的手术时间、意识恢复时间、住院时间及治疗前后神经功能缺损评分、治疗效果、死亡情况、并发症发生情况、预后情况。结果小骨窗开颅术组的手术时间、意识恢复时间及住院时间均短于骨瓣开颅术组,差异有统计学意义(P<0.05)。治疗前,两组神经功能缺损评分比较差异无统计学意义(P>0.05)。治疗后,小骨窗开颅术组神经功能缺损评分为(6.4±0.8)分,低于骨瓣开颅术组的(19.2±1.5)分,差异有统计学意义(P<0.05)。小骨窗开颅术组总有效率高于骨瓣开颅术组,死亡率及并发症发生率低于骨瓣开颅术组,差异有统计学意义(P<0.05)。小骨窗开颅术组临床预后情况优于骨瓣开颅术组,差异有统计学意义(P<0.05)。结论小骨窗开颅术治疗高血压脑出血具有创伤小、并发症少、意识恢复快、神经功能损伤小、预后好的特点,临床效果优于骨瓣开颅术,值得临床推广使用。

Objective To compare the efficacy and safety of craniotomy with bone flap and small bone window craniotomy in the treatment of hypertensive intracerebral hemorrhage.Methods A total of 80 patients with hypertensive intracerebral hemorrhage were divided by different treatment methods into craniotomy with bone flap group and small bone window craniotomy group,with 40 cases in each group.Craniotomy with bone flap group was treated with clearance of hematoma by craniotomy with bone flap,and small bone window craniotomy group was treated with clearance of hematoma by small bone window craniotomy.Comparison were made on operation time,consciousness recovery time,hospitalization time and neurological deficit scores before and after treatment,treatment effect,death condition,occurrence of complications,prognosis condition between the two groups.Results Small bone window craniotomy group had shorter operation time,consciousness recovery time and hospitalization time than craniotomy with bone flap group,and the difference was statistically significant(P<0.05).Before treatment,both groups had no statistically significant difference in neurological deficit scores(P>0.05).After treatment,small bone window craniotomy group had lower neurological deficit scores as(6.4±0.8)points than(19.2±1.5)points in craniotomy with bone flap group,and the difference was statistically significant(P<0.05).Small bone window craniotomy group had higher total effective rate than craniotomy with bone flap group,and lower death rate and incidence of complications than craniotomy with bone flap group.Their difference was statistically significant(P<0.05).Small bone window craniotomy group had better clinical prognosis situation than craniotomy with bone flap group,and the difference was statistically significant(P<0.05).Conclusion Small bone window craniotomy shows characteristics of small trauma,less complications,fast consciousness recovery,small neurological damage and good prognosis in treating hypertensive intracerebral hemorrhage,and the clinical effect is better than craniotomy with bone flap.It is worthy of clinical promotion and application.