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目的探讨钻孔冲洗骨膜下置管持续引流治疗症状性慢性硬膜下血肿的疗。方法选取我院收住的有明显神经功能缺失的单侧慢性硬膜下血肿患者40例,行钻孔术后,采用随机数字表法以及随机数余数分组法随机分为骨膜下持续引流治疗组20例,硬膜下持续引流组20例,两组术后均常规药物治疗。计算各组患者术前及术后血肿量变化以及术后硬膜下血肿复发、并发症发生及术后引流量情况,并比较两种引流方法治疗效果的差异。结果两组术后血肿量变化差异无统计学意义(P=0.619,0.639),但术后同侧颅内硬膜下血肿复发率以及术后癫痫发生率,骨膜下引流组低于硬膜下引流组(P=0.005,0.007)。而且,两组患者术后24小时内引流量比较,骨膜下引流治疗组较硬膜下引流组更为彻底,差异有统计学意义(P=0.000);两组术后24~48小时内引流量及术后48小时内引流量比较,硬膜下引流组会导致过度引流,差异有统计学意义(P=0.000,0.000)。结论颅骨钻孔置管骨膜下引流治疗慢性硬膜下血肿与硬膜下引流比较,慢性硬膜下血肿清除效果无明显区别,但更有利于减少术后血肿复发及术后并发症的发生,原因为骨膜下引流可以规避手术对蛛网膜的二次损伤,手术过程更安全,值得一些基层医疗单位推广应用。
Objective To investigate the treatment of chronic subdural hematoma by drilling and perfused continuous subdural drainage. Methods Forty patients with unilateral chronic subdural hematoma who had obvious neurological deficits in our hospital were enrolled. After drilling, they were randomly divided into subperiosteal continuous drainage treatment group (random number table method and random number grouping method) 20 cases, 20 cases of continuous subdural drainage group, both groups were routine conventional drug treatment. The changes of hematoma volume, the recurrence of postoperative subdural hematoma, the incidence of complications and the amount of postoperative drainage were calculated. The difference of the therapeutic effect between the two drainage methods was compared. Results There was no significant difference in postoperative hematoma volume between the two groups (P = 0.619,0.639). However, the recurrence rate of ipsilateral intracranial subdural hematoma and the incidence of postoperative epilepsy were lower in subperiosteal drainage group than in subdural Drainage group (P = 0.005,0.007). Moreover, the two groups of patients within 24 hours after drainage volume comparison, subdural drainage group was more complete than the subdural drainage group, the difference was statistically significant (P = 0.000); two groups within 24 to 48 hours after the operation Flow and postoperative drainage within 48 hours, subdural drainage group will lead to excessive drainage, the difference was statistically significant (P = 0.000,0.000). Conclusion Compared with subdural drainage, subdural hematoma with subdural drainage by skull drilling and subdural drainage has no significant difference in the removal of chronic subdural hematoma, but it is more conducive to reduce postoperative recurrence of hematoma and postoperative complications, The reason is that subperiosteal drainage can avoid surgery secondary damage to the arachnoid, the operation process is more secure, it is worth some primary medical units to promote the application.