硬膜外穿刺引流术与骨瓣开颅血肿清除术治疗小儿硬膜外血肿的临床研究

Clinical research of epidural puncture and drainage and evacuation of hematoma by craniotomy with bone flap in the treatment of children with epidural hematoma

目的对比分析两种不同手术方法治疗小儿急性硬膜外血肿(EDH)的临床疗效。方法回顾性分析2014年1月至2020年7月普宁市人民医院收治的创伤性EDH患者80例,根据不同的手术方法分为开颅组和微创组,每组各40例。开颅组(n=40)采用骨瓣开颅血肿清除术治疗,微创组(n=40)采用YL-1型一次性颅内血肿粉碎穿刺针进行硬膜外穿刺引流术治疗。对比两组治疗及手术情况,包括术中出血量、术后残余血肿量、术后住院时间及术后并发症情况。并发症主要包括继发出血、感染、外伤性癫痫等。随访3个月,采用格拉斯哥预后评分(GOS)进行评估比较两组患儿的预后情况。结果微创组术中出血量明显低于开颅组,住院时间明显短于开颅组,差异有统计学意义(P<0.05)。微创组术后残余血肿量与开颅组相比,差异无统计学意义(P>0.05)。微创组术后并发症发生率明显低于开颅组,差异有统计学意义(P<0.05)。微创组和开颅组治疗总有效率相比,差异无统计学意义(P>0.05)。随访3个月,微创组恢复良好率明显高于开颅组,差异有统计学意义(P<0.05)。结论采用微创穿刺引流术治疗小儿外伤性EDH,可明显减少术中出血量和术后残余血肿量,减少住院时间,微创穿刺引流术治疗小儿外伤性EDH是安全有效的。

Objective To compare and analyze the clinical efficacy of two different surgical methods in the treatment of children with acute epidural hematoma(EDH).Methods A total of 80 patients with traumatic EDH admitted to Puning People's Hospital of Guangdong Province from January 2014 to July 2020 were retrospectively analyzed.They were divided into the craniotomy group(n=40)and the minimally invasive group(n=40)according to different surgical methods.The craniotomy group was treated with evacuation of hematoma by craniotomy with bone flap,while the minimally invasive group was treated with YL-1 disposable intracranial hematoma crushing puncture needle for epidural puncture and drainage.The therapeutic and operation conditions of the two groups were compared,including the intraoperative hemorrhage volume,amount of postoperative residual hematoma,postoperative hospitalization days and postoperative complications.Complications mainly included secondary hemorrhage,infection and traumatic epilepsy,etc.After 3 months of follow-up,the good recovery rate of prognosis in the two groups of children was compared by Glasgow outcome scale(GOS).Results The intraoperative hemorrhage volume and hospitalization days in the minimally invasive group were significantly lower than those in the craniotomy group,with statistically significant differences(P<0.05).There was no statistically significant difference in the amount of residual hematoma between the minimally invasive group and the craniotomy group(P>0.05).The incidence of postoperative complications in the minimally invasive group was significantly lower than that in the craniotomy group,with statistically significant difference(P<0.05).There was no statistically significant difference in the total effective rate between the minimally invasive group and the craniotomy group(P>0.05).After 3 months of followup,the good recovery rate of the minimally invasive group was significantly higher than that of the craniotomy group,with statistically significant difference(P<0.05).Conclusion Minimally invasive puncture and drainage in the treatment of traumatic EDH in children can obviously reduce the intraoperative hemorrhage volume and the amount of residual hematoma after operation and decrease the hospitalization days.Therefore,minimally invasive puncture and drainage is safe and effective in the treatment of traumatic ED H in children.