摘要目的 探讨颅内压监测下对单侧急性硬膜下血肿(ASDH)行骨瓣复位的治疗效果.方法 采用回顾性病例对照研究分析2014年7月--2017年12月新疆医科大学第一附属医院收治的139例单侧ASDH患者临床资料,其中男84例,女55例;年龄19 ～87岁,平均53岁.人院时格拉斯哥昏迷评分(GCS)3 ～5分63例,6～8分76例.伴单侧腔孔散大40例,双侧瞳孔散大16例.按照手术方式不同,将患者分为研究组(61例)和对照组(78例).研究组采用颅内压监测下开颅血肿清除并根据实际颅内压情况决定是否行骨瓣复位,对照组全部采用开颅血肿清除并行标准大骨瓣减压术(DC).记录研究组骨瓣复位的成功率.比较两组术后3个月并发症及术后6个月格拉斯哥预后评分(GOS). 结果 患者均获随访1～6个月,平均5.5个月.研究组最终骨瓣复位23例,骨瓣复位率为38％.术后3个月研究组硬膜下积液(9∶25)、脑积水(7∶19)、颅骨缺损区脑膨出(5∶18)治疗效果均明显优于对照组(P＜0.05).术后6个月GOS:研究组良好25例,中残9例,重残10例,植物生存7例,死亡10例;对照组良好6例,中残21例,重残15例,植物生存10例,死亡26例.研究组预后较好(良好及中残)例数、死亡例数与对照组比较差异有统计学意义(P均＜0.05). 结论 在颅内压监测下对单侧ASDH行骨瓣复位治疗可减少并发症的发生,并提高患者生存质量.

abstractsObjective To investigate the effect of bone flap reduction on unilateral acute subdural hematoma (ASDH) under intracranial pressure monitoring.Methods A retrospective case control study was conducted to analyze the clinical data of 139 patients with unilateral ASDH admitted to the First Affiliated Hospital of Xinjiang Medical University from July 2014 to December 2017.There were 84 males and 55 females,aged 19-87 years (mean,53 years).At the time of admission,the Glasgow Coma Score (GCS) was 3-5 points in 63 patients and 6-8 points in 76.There were 40 patients with unilateral cavity dilation and 16 cases with bilateral pupil dilation.According to the different surgical methods,the patients were divided into study group (n =61) and control group (n =78).The study group removed the cranial hematoma under cranial pressure monitoring and determined whether to perform bone flap reduction according to the actual intracranial pressure.The control group was treated with craniotomy hematoma removal and standard large bone decompressed craniectomy (DC).The success rate of bone flap reduction in the study group was recorded.The complications at postoperative 3 months and the Glasgow Outcome Score (GOS) at postoperative 6 months were compared.Results All patients were followed up for 1-6 months,average 5.5 months.In the study group,23 patients underwent bone flap reduction,and the bone flap reduction rate was 38％.At postoperative 3 months,the study group showed better efficacy in subdural effusion (9:25),hydrocephalus (7 ∶19),and brain swelling in the skull defect area(5 ∶ 18) than the control group (P ＜0.05).Based on the GOS at 6 months after operation,in the study group,25 patients were with good results,nine with moderate disability,10 with heavy disability,seven with plant survival,and 10 died;in the control group,six patients were with good results,21 with moderate disability,15 with heavy disability,10 with plant survival,and 26 died.The number of patients with good prognosis (good and moderate disability) and the number of deaths in the study group were statistically different from those in the control group (P ＜ 0.05).Conclsion In the treatment of unilateral ASDH,bone flap reduction under intracranial pressure monitoring can reduce the incidence of complications and improve the life quality of patients.