治疗高血压脑出血去骨瓣减压术式与术后硬膜下积液的关系

Relationship between decompressive craniectomy and postoperative subdural effusion in the treatment of hypertensive intracerebral hemorrhage

目的分析治疗高血压脑出血(HICH)采用去骨瓣减压术式与术后硬膜下积液的关系。方法HICH患者124例分为行额颞顶部标准大骨瓣的去骨瓣减压术46例(A组)和额颞顶部马蹄瓣的去骨瓣减压术78例(B组),比较两组术后硬膜下积液发生率,分析HICH患者骨窗面积、骨窗最高水平面至头顶水平面的距离、骨窗最低水平面至中颅底的距离与硬膜下积液的关系。结果A组术后硬膜下积液发生率高于B组(P<0.01)。HICH患者术后硬膜下积液发生比例随骨窗面积增大而增高(P<0.01),骨窗最高水平面至头顶水平面的距离越大,则术后硬膜下积液发生比例越低(P<0.01),骨窗最低水平面至中颅底的距离越小,则术后硬膜下积液发生比例越高(P<0.05)。结论需在有效减压的基础上,合理设计去除的骨瓣相对位置并缩小其面积,从而更好预防HICH患者术后硬膜下积液发生。

Objective To analyze the relationship between decompressive craniectomy and postoperative subdural effusion in the treatment of hypertensive intracerebral hemorrhage(HICH).Methods A total of 124 patients with HICH were divided into two groups of A(decompressive craniectomy with standard large bone flap at top of frontotemporal area,46 cases)and B(decompressive craniectomy with horseshoe flap at top of frontotemporal area,78 cases).Incidence of postoperative subdural effusion between the two groups was compared.Relationship between postoperative subdural effusion and bone window area,distance from the highest level of bone window to top level of head,distance from the lowest level of bone window to base level of middle skull in the patients with HICH were analyzed.Results The incidence of postoperative subdural effusion was higher in group A than that in group B(P<0.01).The proportion of HICH patients with postoperative subdural effusion was increased with the increase of bone window area(P<0.01).The greater distance from the highest level of bone window to top level of head,the lower proportion of postoperative subdural effusion(P<0.01).The smaller distance from the lowest level of bone window to base level of middle skull,the higher proportion of postoperative subdural effusion(P<0.05).Conclusion On the basis of effective decompression,it is necessary to reasonably design the relative position of the bone flap removed and reduce its area,so as to better prevent postoperative subdural effusion in the patients with HICH.