单骨孔与双骨孔技术外科治疗慢性硬膜下血肿临床对照研究

目的探讨单骨孔与双骨孔技术治疗慢性硬膜下血肿（CSDH）的临床疗效。方法选取安国市人民医院2010年3月～2012年12月CSDH患者96例,随机分观察组及对照组,每组各48例;观察组采用双骨孔技术治疗,对照组采用单骨孔技术治疗。临床症状的比较采用Markwalder神经功能评分。观察两组患者血肿清除情况,平均住院时间、术后残余量、并发症发生情况等。结果①观察组血肿完全清除率91.67%（44/48）]高于对照组79.17%（38/48）],观察组病死率0.00%（0/48）]及术后残余量（18.9±4.6）mL]均低于对照组4.16%（38/48）、（18.9±4.6）mL],差异均有统计学意义（P〈0.05）。②两组治疗后Markwalder神经功能评分（0.37±0.17）、（0.48±0.21）分]均低于治疗前（1.45±0.23）、（1.48±0.25）分],差异有统计学意义（P〈0.05）。观察组治疗后Markwalder神经功能评分与对照组比较,差异无统计学意义（P〉0.05）。③观察组住院天数（6.8±3.4）d]、并发症发生率8.33%（4/48）]、复发率4.16%（2/48）]均低于对照组（10.5±3.9）d、25.00%（12/48）、16.67%（8/48）],差异均有统计学意义（P〈0.05）。结论双骨孔技术治疗CSDH疗效显著,血肿清除率高,损伤小且并发症少,可作为外科治疗CSDH的一种较理想的手术方式。

Therapeutic effect of one burr-hole craniotomy and two burr-hole craniotomy for chronic subdural hematoma

Objective To compare the therapeutic effect of one burr-hole craniotomy and two burr-hole craniotomy for chronic subdural hematoma （CSDH）. Methods 96 patients in the People＇s Hospital of Anguo City from March 2010 to December 2012 with CSDH were selected and divided into observation group and control group with 48 cases in each group. Observation group was treated with two burr-hole craniotomy, control group was treated with one burr-hole craniotomy. Markwalder neurological scores were used to evaluate the clinical symptoms. The clearance of hematomas, the hospital stays, the residual hematomas and the postoperative complications were observed in the two groups. Results ①Complete clearance of hematomas in observation group 91.67%（44/48）] was higher than that in control group 79.17%（38/48）], mortality rate, the residual hematomas in observation group 0.00% （0/48）, （18.9±4.6） mL] were lower than those in control group 4.16% （38/48）, （18.9±4.6） mL], the differences were statistically significant （P 〈 0.05）. ②Markwalder neurological scores in the two groups after the treatment （0.37±0.17）, （0.48±0.21） scores] were all lower than those before the treatment （1.45±0.23）, （1.48±0.25） scores], the differences were statistically significant （P 〈 0.05）. The differences of Markwalder neurological scores in the two groups after the treatment was not statistically significant （P 〉 0.05）. ③The hospital stays, occurrence rate of complications, recurrence rate in observation group （6.8±3.4） d, 8.33% （4/48）, 4.16%（2/48）] were all lower than those in control group （10.5±3.9） d, 25.00% （12/48）, 16.67% （8/48）], the differences were statistically significant （P 〈 0.05）. Conclusion Significant effect of the two burr-hole craniotomy for CSDH is remarkable. The hematoma evacuation rate is high, damage and fewer complications are small, it is a good surgical treatment for CSDH surgery.