微创治疗急性颅脑损伤开颅术后远隔部位迟发性硬膜外血肿的优势评价

摘要

Objective To discuss of minimally invasive craniotomy in acute brain injury after remote part of delayed epidural hematoma of the short-term and long-term advantage. Methods 96 patients were randomly from April 2009 to October 2012 craniotomy in our hospital after acute craniocerebral injury appeared distant parts of delayed epidural hematoma average divided into two groups,one group of minimally invasive hematoma in 48 cases,set as the experimental group,the other group underwent conventional craniotomy hematoma removal 48 an example,set as the control group,compared two groups of patients with hematoma and related complication rate, recurrence rate of incidence,and in six months after the follow-up investigation of patients with ADL score and Glasgow outcome score (GOS score). Results The two groups of delayed epidural hematoma in 1 days after operation,contrast:experimental group 46 cases of hematoma successfully;the control group of 47 cases of hematoma of success. 3 days after the operation:1 cases in experimental group compared with the control group of 1 cases of recurrent relapse.After 15 days of contrast:experimental group 48 cases, no complications appeared;delayed healing of incision in 9 cases, 4 cases of incision infection in 48 cases of the control group. Comparison of follow-up after six months:42 cases in the experimental group GOS score of 5 points, 5 points in 4 cases, 1 cases of 3, ADL score of 37 cases of more than 60 points, in 8 cases of 40-60, 3 cases in the following 20 points;19 patients in control group GOS patients were scored 5 points, 10 points in 4 cases, 15 cases of 3 points, 4 points in 2 cases, 23 cases of ADL score more than 60 points,18 cases of 40~60,7 cases in the following 20 points. Conclusion The treatment of craniotomy delayed epidural hematoma, minimally invasive hematoma is obviously better than the conventional craniotomy evacuation of hematoma.%　　目的探讨微创在急性颅脑损伤开颅术后远隔部位迟发性硬膜外血肿的近期及远期优势。方法选取2009年4月-2012年10月佛山市顺德区桂洲医院收治的行急性颅脑损伤开颅术后出现远隔部位迟发性硬膜外血肿的96例患者，随机分为两组，各48例。实验组行微创血肿清除术，对照组行常规开颅血肿清除术，比较两组患者血肿清除率、血肿复发率及相关并发症发生率，并在6个月后随访调查患者ADL评分和格拉斯哥预后评分（GOS评分）。结果两组迟发性硬膜外血肿患者在术后1 d比较，实验组46例血肿清除成功，对照组47例血肿清除成功；术后3 d比较，实验组1例复发，对照组1例复发；术后15 d比较，实验组未出现并发症，对照组出现切口延期愈合9例、切口感染4例。6个月后随访，实验组42例GOS评分5分，5例4分，1例3分，ADL评分37例＞60分，8例40～60分，3例＜20分；对照组19例GOS评分5分，10例4分，15例3分，4例2分，ADL评分23例＞60分，18例40～60分，7例＜20分。结论治疗开颅术后迟发性硬膜外血肿，微创血肿清除术明显优于常规的开颅血肿清除术，值得临床推广应用。