定向局部扩大骨孔钻颅引流慢性硬膜下血肿疗效分析  

Analysis of Therapeutic Effect of Directional Local Enlarged Skull Holes in Burr Hole and Drainage for Chronic Subdural Hematoma

作　　者：程序曲[1] 赵富文[1] 支文勇[1] CHENG Xuqu;ZHAO Fuwen;ZHI Wenyong(Changshu No.2 People’s Hospital,Changshu 215500,China)

机构地区：[1]江苏省常熟市第二人民医院,江苏常熟215500

出　　处：《中国医学创新》2019年第25期142-146,共5页Medical Innovation of China

摘　　要：目的:比较标准、扩大、定向局部扩大(钻戒样)骨孔钻颅引流慢性硬膜下血肿的疗效,探讨最适宜颅骨孔形状。方法:回顾性分析慢性硬膜下血肿标准骨孔50例、扩大骨孔40例、钻戒样骨孔40例钻颅引流术患者的临床资料。结果:三组手术时间比较,差异无统计学意义(P>0.05)。术后标准骨孔组额颞叶脑挫伤3例,急性硬膜下血肿6例,复发3例;扩大骨孔组急性硬膜外血肿1例,急性硬膜外、下血肿1例及对侧急性硬膜下血肿1例,复发0例;钻戒样骨孔组急性硬膜外血肿1例,复发1例。标准骨孔组和钻戒样骨孔组颅内出血情况比较,差异有统计学意义(P<0.05)。三组GOS预后评分比较,差异无统计学(P>0.05)。结论:慢性硬膜下血肿钻颅引流术采用定向局部扩大骨孔(钻戒样骨孔)实现了微创和安全的统一。标准骨孔插入引流管受限,增加颅内出血风险,大多数情况下扩大骨孔增加了不必要的创伤。Objective:To compare the therapeutic effect of standard,enlarged and directional local enlarged(diamond ring-like)bone hole drilling for drainage in chronic subdural hematoma and to explore the most suitable shape of the skull hole.Method:The clinical data of 50 cases of standard bone hole,40 cases of enlarged bone hole and 40 cases of diamond ring-like bone hole drainage were retrospectively analyze.Result:There was no significant difference in operation time among three groups.Postoperatively,there were 3 cases of frontotemporal cerebral contusion,6 cases of acute subdural hematoma and 3 cases of recurrence in standard bone hole group.1 case of acute epidural hematoma,1 case of acute epidural and subdural hematoma,1 case of contralateral acute subdural hematoma and 0 case of recurrence in enlarged bone hole group.1 case of acute epidural hematoma and 1 case of recurrence in diamond ring-like bone hold group.There was a statistically significant difference between the standard bone hole group and the diamond ring-like bone hole group in intracranial hemorrhage complications(P<0.05).There was no statistically significant difference in GOS among three groups(P>0.05).Conclusion:The burr hole and drainage of chronic subdural hematoma by directional local enlarged bone hole achieves the unity of minimally invasion and safety.The insertion of drainage tube is restricted in standard bone hold,which increases the risk of intracranial hemorrhage.In most cases,enlargement of the bone hold increases unnecessary trauma.

关 键 词：慢性硬膜下血肿 钻颅引流术 颅骨孔 并发症 

分 类 号：R651.15[医药卫生—外科学]