双骨瓣技术在枕下乙状窦后入路中的应用研究

Application of dual bone flap craniotomy via the suboccipital retrosigmoid approach

目的探索双骨瓣技术在枕下乙状窦后入路中的临床应用效果。方法前瞻性纳入2021年8月—2022年10月郑州大学第一附属医院神经外科行枕下乙状窦后入路手术治疗的60例患者,随机分为双骨瓣组和单骨瓣组,每组30例。结合术中术后资料,记录两组术中静脉窦损伤情况、术区骨质缺损大小、术后常见并发症情况。结果双骨瓣组术区骨质缺损2.0~4.2 mm,平均(2.78±0.70)mm;单骨瓣组术区骨质缺损4~11 mm,平均(7.78±1.64)mm,两组间比较,差异有统计学意义(P=0.000)。双骨瓣组术中乙状窦损伤1例,单骨瓣组术中乙状窦损伤3例。双骨瓣组1例伤口愈合不良,1例颅内感染;单骨瓣组1例皮下积液,2例颅内感染。结论采取枕下乙状窦后双骨瓣开颅可减少骨质缺损,确保手术安全、高效进行,能取得满意的临床效果。

Objective To investigate the clinical application effect of dual bone flap craniotomy via the suboccipital retrosigmoid approach.Methods A total of 60 patients who underwent surgical treatment via the suboccipital retrosigmoid approach in Department of Neurosurgery,The First Affiliated Hospital of Zhengzhou University,from August 2021 to October 2022 were enrolled in this prospective study,and they were randomly divided into dual bone flap(DBF)group and single bone flap(SBF)group,with 30 patients in each group.With reference to intraoperative and postoperative data,the two groups were observed in terms of intraoperative venous sinus injury,the gap of bone defect,and postoperative complications.Results The mean gap of bone defect was 2.78±0.70 mm(range 2.0-4.2 mm)in the DBF group and 7.78±1.64 mm(range 4-11 mm)in the SBF group,with a significant difference between the two groups(P=0.000).There was 1 patient with intraoperative sigmoid sinus injury in the DBF group and 3 patients with intraoperative sigmoid sinus injury in the SBF group.In the DBF group,there was 1 patient with poor wound healing and 1 patient with intracranial infection,while in the SBF group,there was 1 patient with subcutaneous effusion and 2 patients with intracranial infection.Conclusions Dual bone flap craniotomy via the suboccipital retrosigmoid approach can effectively reduce bone defects,guarantee surgical safety and efficiency,and achieve satisfactory clinical outcomes.