额颞小骨瓣开颅术在高血压基底节脑出血并脑疝中的应用

Application of frontotemporal small bone flap craniotomy in hypertensive basal ganglia intracerebral hemorrhage with cerebral herniation

目的:探讨额颞小骨瓣开颅术在基底节高血压脑出血(HICH)并脑疝中的应用效果。方法:选择2020年5月至2021年4月本院收治的基底节HICH并脑疝患者90例,以随机数字表划分为两组,各45例。对照组行大骨瓣开颅去骨瓣减压术,研究组行额颞小骨瓣开颅术。比较两组术中情况(手术时间与术中出血量)与住院时间、格拉斯哥预后评分(GOS)、术后并发症情况,以及术后不同时间点的日常生活能力及生活质量。结果:研究组手术时间、术中出血量、住院时间显著低于对照组(P<0.05)。研究组预后良好率显著高于对照组(P<0.05)。研究组术后并发症发生率显著低于对照组(P<0.05)。术后14d时,两组患者BI指数与SF-36量表评分比较差异无统计学意义(P>0.05);术后6个月,研究组患者BI指数与SF-36量表评分显著高于对照组(P<0.05)。结论:基底节HICH并脑疝患者应用额颞小骨瓣开颅技术进行治疗,能够有效保障预后,提高日常生活能力与生活质量,安全性佳,具有临床应用价值。

Objective:To investigate the effect of frontotemporal craniotomy in the treatment of basal ganglia hypertensive intracerebral hemorrhage(HICH)with brain herniation.Methods:A total of 90 patients with basal ganglia HICH and cerebral herniation who were admitted to Changyi People's Hospital from May 2020 to April 2021 were selected and divided into two groups by random number table,with 45 cases in each group.The control group underwent decompressive craniotomy with large craniotomy,and the study group underwent small frontotemporal craniotomy.The intraoperative conditions(operation time and intraoperative blood loss),hospital stay,Glasgow Outcome Scale(GOS),postoperative complications,and daily living ability and quality of life at different postoperative time points were compared between the two groups.Results:The operation time,intraoperative blood loss and hospital stay in the study group were significantly lower than those in the control group(P<0.05).The good prognosis rate of the study group was significantly higher than that of the control group(P<0.05).The incidence of postoperative complications in the study group was significantly lower than that in the control group(P<0.05).At 14 days after operation,there was no significant difference in BI index and SF-36 scale score between the two groups(P>0.05);6 months after operation,the BI index and SF-36 scale score in the study group were significantly higher than those in the study group.control group(P<0.05).Conclusion:The frontotemporal small bone flap craniotomy for the treatment of patients with basal ganglia HICH complicated with brain herniation can effectively guarantee the prognosis,improve the ability to drive and improve the quality of life in daily life,with good safety and clinical value.