小骨窗微创血肿清除与大骨瓣开颅血肿清除治疗重症基底节血肿效果比较  

Comparison of Clinical Outcomes between Minimally Invasive Hematoma Evacuation with Small Bone Window and Craniotomy Hematoma Evacuatio with Large Bone Flap for Severe Basal Ganglia Hematoma

作　　者：刘轶刚 赵梦 LIU Yigang;ZHAO Meng(Department of Neurosurgery,989 Hospital of the Chinese PLA Joint Logistics Support Force,Luoyang Henan 471000,China;Department of Anesthesiology,989 Hospital of the Chinese PLA Joint Logistics Support Force,Luoyang Henan 471000,China)

机构地区：[1]中国人民解放军联勤保障部队第九八九医院神经外科,河南洛阳471000 [2]中国人民解放军联勤保障部队第九八九医院麻醉科,河南洛阳471000

出　　处：《临床研究》2025年第2期26-29,共4页Clinical Research

摘　　要：目的探究重症基底节血肿患者接受小骨窗微创血肿清除与大骨瓣开颅血肿清除治疗的临床效果。方法数据收集时间为2020年1月至2024年3月,选择中国人民解放军联勤保障部队第九八九医院收治的70例重症基底节血肿患者作为本次研究对象,根据随机数字表法分为大骨瓣组(35例,大骨瓣开颅血肿清除治疗)与小骨窗组(35例,小骨窗微创血肿清除治疗),对比两组手术情况及治疗效果。结果出院时,两组格拉斯哥昏迷评分(GCS)、Barthel指数较手术前升高、美国国立卫生研究院脑卒中量表(NIHSS)较手术前降低,且小骨窗组GCS评分与Barthel指数高于大骨瓣组,NIHSS低于大骨瓣组,差异具有统计学意义(P<0.05)。小骨窗组手术时间、住院时间短于大骨瓣组,术中出血量少于大骨瓣组,血肿清除率高于大骨瓣组,差异具有统计学意义(P<0.05)。小骨窗组总体预后情况优于大骨瓣组,差异具有统计学意义(P<0.05)。小骨窗组并发症发生率(2.86%)低于大骨瓣组(17.14%),差异具有统计学意义(P<0.05)。结论两种手术均可改善重症基底节血肿状况,但相比较而言,小骨窗微创血肿清除治疗在改善患者昏迷程度与神经功能损伤程度、提高日常生活活动能力与血肿清除率、缩短手术时间、住院时间、减少术中出血量与并发症、改善预后更具优势,值得临床应用。Objective To investigate the clinical effects of minimally invasive hematoma evacuation with a small bone window compared to craniotomy hematoma evacuatio with a large bone flap in patients with severe basal ganglia hematoma.Methods Data collection occurred from January 2020 to March 2024,involving 70 patients with severe basal ganglia hematoma treated at the 989 Hospital of the PLA Joint Logistics Support Force were selected as the subjects of this study.Patients were randomly assigned to the large bone flap group(35 cases,craniotomy for hematoma evacuation with large bone flap)and the small bone window group(35 cases,minimally invasive hematoma evacuation with small bone window).Surgical conditions and treatment outcomes of the two groups were compared.Results At discharge,both groups showed improvements in Glasgow Coma Scale(GCS)scores and Barthel index,and reductions in the National Institutes of Health Stroke Scale(NIHSS)scores compared to pre-surgery levels.The small bone window group had higher GCS and Barthel index scores and lower NIHSS scores than the large bone flap group,with statistically significant differences(P<0.05).The small bone window group also had shorter surgery duration,shorter hospital stay,less intraoperative bleeding,and higher hematoma clearance rates compared to the large bone flap group,with statistically significant differences(P<0.05).Overall prognosis in the small bone window group was better than that in the large bone flap group,with statistically significant differences(P<0.05).The incidence of complications in the small bone window group(2.86%)was lower than that in the large bone flap group(17.14%),with statistically significant differences(P<0.05).Conclusion Both surgical techniques can improve the condition of severe basal ganglia hematoma.However,minimally invasive hematoma evacuation using a small bone window offers significant advantages in improving coma levels,reducing the degree of neurological impairment,enhancing daily living activity,achieving higher hematoma clear

关 键 词：小骨窗微创血肿清除 重症基底节血肿 大骨瓣开颅血肿清除 

分 类 号：R743.34[医药卫生—神经病学与精神病学]