小儿外伤性硬膜外血肿微创穿刺术与骨瓣开颅血肿清除术的效果比较

目的 比较分析微创穿刺术与骨瓣开颅血肿清除术治疗小儿外伤性硬膜外血肿的有效性及预后。方法选择2015年6月～2019年6月在广西医科大学附属武鸣医院神经外科接受手术治疗的64例外伤性硬膜外血肿患儿为研究对象,根据手术方式不同分为两组,微创组(n=32)采用微创穿刺术治疗,开颅组(n=32)采用骨瓣开颅血肿清除术治疗,比较两组的手术情况、术后并发症发生率、治疗效果、术后面部表情疼痛评分及预后良好率。结果 微创组的手术时间明显短于开颅组,术中出血量显著少于开颅组,且术后并发症发生率明显低于开颅组,差异均有统计学意义(P0.05),但两组治疗总有效率、血肿完全吸收时间比较,差异无统计学意义(P0.05)。微创组患儿术后24 h、48 h面部表情疼痛评分均显著少于开颅组(P0.05),且术后随访3个月,微创组患儿预后良好率较开颅组明显增加(P0.05)。结论 微创穿刺术与骨瓣开颅血肿清除术治疗小儿外伤性硬膜外血肿的疗效相当,但微创穿刺术具有术中出血量少、手术时间短、术后疼痛轻、并发症少、预后恢复佳等优点,更值得在临床中推广应用。

Comparison of the effect between minimally invasive puncture and bone flap craniotomy hematoma removal on traumatic epidural hematoma in children

Objective To compare and analyze the effectiveness and prognosis of minimally invasive puncture and bone flap craniotomy hematoma removal for the treatment of traumatic epidural hematoma in children.Methods 64 children with traumatic epidural hematoma who underwent surgical treatment at the Department of Neurosurgery in the Wuming Hospital Affiliated to Guangxi Medical University from June 2015 to June 2019 were selected as the research subjects.They were divided into two groups according to different surgical methods.The minimally invasive group(n=32) was treated with minimally invasive puncture,and the craniotomy group(n=32) was treated with bone flap craniotomy for hematoma removal.The surgical conditions,incidence of postoperative complications,treatment effect,postoperative facial expression pain score,and good prognosis rate were compared between the two groups.Results The operation time of the minimally invasive group was significantly shorter than that of the craniotomy group,the intraoperative blood loss was significantly less than that of the craniotomy group,and the incidence of postoperative complications was significantly lower than that of the craniotomy group.The differences were statistically significant (P<0.05).But there were no significant differences in the total effective rate of treatment and complete absorption time of hematoma between the two groups(P>0.05).The facial expression pain scores at 24 hours and 48 hours after surgery in the minimally invasive group were significantly lower than those in the craniotomy group(P<0.05).And after 3 months of follow-up,the prognosis of the patients in the minimally invasive group was significantly higher than that in the craniotomy group (P<0.05).Conclusion Minimally invasive puncture is equivalent to bone flap craniotomy hematoma removal for the treatment of traumatic epidural hematoma in children,but minimally invasive puncture has the advantages of less intraoperative blood loss,shorter operation time,less postoperative pain,fewer complications and good prognosis and recovery.It is more worthy of popularization and application in the clinic.