立体定向软通道颅内血肿清除引流术在颅脑创伤基底节血肿清除中的应用效果

温桂菲 徐龙彪 韦超

[摘要] 目的 探討立体定向软通道颅内血肿清除引流术在颅脑创伤基底节血肿清除中的应用效果。 方法 回顾性分析2017年6月～2019年12月在我院诊断治疗的颅脑创伤后基底节出血患者60例的临床资料，其中30例患者采用立体定向软通道颅内血肿清除引流术治疗为观察组，30例患者采用小骨窗开颅术治疗为对照组，比较两组的手术时间、术后住院时间、复发率;比较两组治疗后1、3个月NIHSS评分与Barthel指数;比较两组治疗后3个月GOS评价。 结果 （1）治疗后1个月、3个月，两组NIHSS评分均低于治疗前，差异有统计学意义（P<0.05）;治疗后1、3个月，观察组NIHSS评分低于对照组，差异有统计学意义（P<0.05）。（2）观察组手术时间较对照组短，术后住院时间较对照组短，差异有统计学意义（P<0.05）;两组均有1例血肿复发，差异无统计学意义（P>0.05）。（3）治疗后1个月、3个月，两组Barthel指数均显著高于治疗前，差异有统计学意义（P<0.05）;治疗后1个月、3个月，观察组Barthel指数显著高于对照组，差异有统计学意义（P<0.05）。（4）秩和检验显示，观察组治疗后3个月GOS评价预后显著优于对照组，差异有统计学意义（P<0.05）。 结论 立体定向软通道颅内血肿清除引流术治疗颅脑创伤患者基底节血肿具有创伤小，定位准确，效果好等优点。

[关键词] 立体定向软通道颅内血肿清除引流术;颅脑创伤;基底节血肿

[中图分类号] R651.12          [文献标识码] B          [文章编号] 1673-9701（2020）15-0108-04

Application effect of stereotactic soft-channel intracranial hematoma removal and drainage in hematoma removal from basal ganglia of craniocerebral trauma

WEN Guifei    XU Longbiao    WEI Chao    FENG Fangjun

Operating Room， Zhuji People's Hospital in Zhejiang Province， Zhuji   311800， China

[Abstract] Objective To investigate the application effect of stereotactic soft-channel intracranial hematoma removal and drainage in the removal of hematomas in basal ganglia of craniocerebral trauma. Methods The clinical data of 60 patients with basal ganglia hemorrhage after traumatic brain diagnosed and treated in the hospital from June 2017 to December 2019 were retrospectively analyzed. 30 patients were enrolled as the observation group treated with stereotactic soft-channel intracranial hematoma removal and drainage， and 30 patients were enrolled as the control group treated with small bone window craniotomy. The operation time， postoperative hospital stay， and recurrence rate were compared between the two groups. The NIHSS score and Barthel index were compared between two groups at 1 and 3 months after treatment. GOS evaluation was compared 3 months after treatment between the two groups. Results （1）At 1 and 3 months after treatment， the NIHSS scores of the two groups were lower than those before treatment， and the difference was statistically significant（P<0.05）. At 1 and 3 months after treatment， the NIHSS score of the observation group was lower than that in the control group， and the difference was statistically significant（P<0.05）. （2）The operation time in the observation group was shorter than that in the control group， and the length of postoperative hospital stay was shorter than that in the control group， with statistically significant difference（P<0.05）. There was one case of hematoma recurrence in both groups， without statistically significant difference（P>0.05）. （3）At 1 and 3 months after treatment， the Barthel index of the two groups was significantly higher than that before treatment， and the difference was statistically significant（P<0.05）. The Barthel index of the observation group was significantly higher than that of the control group， and the difference was statistically significant（P<0.05）.（4）The rank sum test showed that the prognosis of GOS evaluation in the observation group at 3 months after treatment was significantly better than that in the control group， and the difference was statistically significant（P<0.05）. Conclusion Stereotactic soft-channel intracranial hematoma removal and drainage for the treatment of basal ganglia hematoma in patients with craniocerebral trauma has the advantages of less trauma， accurate positioning and good effect.

[Key words] Stereotactic soft-channel intracranial hematoma removal and drainage; Craniocerebral trauma; Basal ganglia hematoma

颅脑损伤是神经外科常见创伤，发生率可居于创伤首位或仅次于四肢骨折，具有较高的死亡率与致残率。目前颅脑损伤的主要原因包括交通事故、建筑业工伤事故、运动损伤、自然灾害等一些不可预料的因素。颅脑损伤具有伤情重、病情变化快、死亡率高等特点。颅脑损伤包括头皮损伤、颅骨骨折、脑损伤。脑损伤是严重的颅脑创伤，包括原发性和继发性脑损伤，其中颅内血肿常见。基底节（Basal ganglia，又称基底神经节）是指从胚胎端脑神经节小丘发育而来的神经核团，是大脑的中心灰质核团，包括杏仁核、纹状体和屏状核，患者一旦发生基底节出血，可出现典型的三偏体征，大量出血可出现意识障碍，病情危重[1，2]。……