新型去骨瓣减压术在大脑中动脉闭塞性脑梗死中的临床应用

Clinical application of novel decompressive craniectomy in middle cerebral artery occlusive cerebral infarction

目的探讨新型去骨瓣减压术在大脑中动脉闭塞性脑梗死中的临床应用。方法回顾性分析2019年10月至2020年9月新乡市中心医院,新乡医学院第四临床学院神经外科收治的96例大脑中动脉闭塞性脑梗死患者的临床资料。其中,49例患者采用传统去骨瓣减压术治疗(简称传统手术组),另47例采用新型去骨瓣减压术治疗(简称新型手术组)。术后3个月对所有患者行临床随访,随访内容包括:采用改良Rankin量表评分(mRS)评估患者预后,其中0~3分为预后良好,4~6分为预后不良;同时询问患者的颞肌萎缩情况。比较两组患者的临床资料、手术时间、术后脑脊液漏和切口感染的发生率、术后3个月颞肌萎缩的发生率及其预后。结果两组患者的年龄、性别、合并原发性高血压、糖尿病、高脂血症、冠状动脉硬化性心脏病或心房颤动、吸烟史、体重指数、从出现症状至手术时间、术前症状严重程度及术前美国国立卫生院神经功能缺损评分间的差异均无统计学意义(均P>0.05),基线基本一致,具有可比性。新型手术组的手术时间较传统手术组短[分别为(68±7)min、(82±8)min,P<0.05],术后脑脊液漏[分别为0%(0/47)、4.1%(2/49)]和切口感染的发生率[分别为2.1%(1/47)、10.2%(5/49)]均较传统手术组低(均P<0.05)。术后3个月,两组mRS评分的差异无统计学意义(P>0.05),但是新型手术组发生颞肌萎缩的概率低于传统手术组[分别为0%(0/47)、8.2%(4/49),P<0.05]。结论与传统去骨瓣减压术比较,新型去骨瓣减压治疗大脑中动脉闭塞性脑梗死患者具有手术时间短、术后脑脊液漏、切口感染及颞肌萎缩发生率低的优势。

Objective To explore the clinical application of novel decompressive hemicraniectomy in middle cerebral artery occlusive cerebral infarction.Methods A retrospective analysis was conducted on the clinical data of 96 patients with middle cerebral artery occlusive cerebral infarction admitted to the Department of Neurosurgery,Xinxiang Central Hospital,the Fourth Clinical College of Xinxiang Medical College from October 2019 to September 2020.Among them,49 patients were treated with conventional decompressive craniectomy(conventional surgery group),and 47 patients were treated with novel decompressive craniectomy(novel surgery group).Clinical follow-up was performed for all patients 3 months after surgery.The content of the follow-up included:the use of modified Rankin scale(mRS)to assess the outcomes of the patients,of which 0 to 3 were classified as favorable outcomes,4 to 6 were classified as poor outcomes;at the same time,the patients were asked about the atrophy of their temporal muscles.The clinical data,operation time,incidences of postoperative cerebrospinal fluid leakage and incision infection,the incidence of temporal muscle atrophy and its outcome were compared between the two groups of patients.Results The age,gender,comorbidity of essential hypertension,diabetes,hyperlipidemia,coronary atherosclerotic heart disease or atrial fibrillation,smoking history,body mass index,time from onset of symptoms to operation,severity of preoperative symptoms,and the preoperative National Institutes of Health Stroke Scale(NIHSS)score were not statistically different between two groups(all P>0.05),and their baseline situations were basically similar and comparable.The operation time of the novel operation group was shorter than that of the conventional operation group(68±7 min vs.82±8 min,P<0.05),the incidences of postoperative cerebrospinal fluid leakage[0%(0/47)vs.4.1%(2/49)]and incision infection[2.1%(1/47)vs.10.2%(5/49)]were lower than those of the conventional surgery group(both P<0.05).At 3 months after surgery,the difference in the mRS score between the two groups was not statistically significant(P>0.05),while the rate of temporal muscle atrophy in the novel surgery group was significantly lower than that in the conventional surgery group[0%(0/47)vs.8.2%(4/49),P<0.05].Conclusion Compared with conventional decompressive craniectomy,the novel decompressive craniectomy for the treatment of middle cerebral artery occlusive cerebral infarction has the advantages of short operation time and low incidences of postoperative cerebrospinal fluid leakage,incision infection as well as temporal muscle atrophy.