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首页> 美国卫生研究院文献>Experimental and Therapeutic Medicine >Randomized controlled study on the curative effects of twist-drill craniotomy and burr-hole craniotomy in the treatment of chronic subdural hematoma
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Randomized controlled study on the curative effects of twist-drill craniotomy and burr-hole craniotomy in the treatment of chronic subdural hematoma

机译：麻花开颅手术治疗慢性硬脑膜下血肿的疗效随机对照研究

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The present randomized controlled study investigated the differences in the curative effects of twist-drill craniotomy (TDC) and burr-hole craniotomy (BHC) in the treatment of chronic subdural hematoma (CSDH). A total of 40 patients diagnosed with CSDH via head computed tomography (CT) who required surgical decompression from January 2016 to January 2017 were enrolled in the present study, and were randomly divided into a TDC group (n=20) and a BHC group (n=20). The modified Rankin scale (mRS) scores of patients were recorded prior to the operation, and at 48 h and 3 months after the operation. The differences in the mRS score (VmRS) among the groups were calculated using the Mann-Whitney U test. The 40 patients enrolled comprised 33 males and 7 females, and there were no significant differences in the general clinical characteristics between the two groups. In the BHC group, 3 patients had a pre-operative mRS score of 5 points, among which 2 cases died at 32 and 45 days after discharge. In the TDC group, 4 patients had a pre-operative mRS score of 5 points, among which 1 case died of epilepsy and pulmonary infection at 1 month after the operation. No difference in the mortality rate was present between the two groups. During the 3-month follow-up, head CT indicated that the intracranial hematoma in a total of 4 patients, including 3 cases in the TDC group and 1 case in the BHC group, completely disappeared. In the BHC group, 3 cases required a repeated incision and drainage after the first operation, while no secondary operation was required in any of the cases of the TDC group. The average length of stay at the hospital (LOS) after TDC was 9.00±2.91 days, which was significantly shorter than that after BHC (14.75±5.95 days). In the total sample of 40 patients, a longer LOS was associated with a higher risk of secondary operation due to recurrence after discharge. The variation value of the mRS score at 3 months after the operation and its ratio vs. the pre-operative score in the TDC group were significantly different from those in the BHC group, suggesting that the improvement of neurological function after TDC was significantly greater than that after BHC. Although 18 patients (90%) in the TDC group were cured, there was no significant difference from the cure rate in the BHC group [15 patients (75%)]. In conclusion, no significant differences were identified in the cure rate and the mortality rate of patients with CSDH after the two types of surgical treatment. However, the mRS score in the TDC group at 3 months after the operation exhibited a significantly greater improvement compared with that in the BHC group, and the overall LOS in the TDC group was significantly shorter than that in BHC group. Therefore, TDC is superior to BHC in the treatment of CSDH (trial registration no. ChiCTR-INR-16008368).
机译：本随机对照研究调查了麻花开颅手术（TDC）和开孔开颅手术（BHC）在治疗慢性硬膜下血肿（CSDH）的疗效上的差异。 2016年1月至2017年1月，共有40例经头部计算机断层扫描（CT）诊断为CSDH的患者需要手术减压，并随机分为TDC组（n = 20）和BHC组（ n = 20）。在手术前以及手术后48小时和3个月记录患者的改良Rankin量表（mRS）评分。使用Mann-Whitney U检验计算各组之间的mRS分数（VmRS）差异。入组的40例患者中，男33例，女7例，两组的一般临床特征无明显差异。在BHC组中，有3例患者的术前mRS评分为5分，其中2例在出院后32和45天死亡。 TDC组4例患者术前mRS评分为5分，其中1例术后1个月死于癫痫和肺部感染。两组之间的死亡率没有差异。在3个月的随访中，头颅CT显示总共4例颅内血肿完全消失，包括TDC组3例和BHC组1例。在BHC组中，有3例在第一次手术后需要重复切开引流，而在TDC组的任何病例中都不需要进行二次手术。 TDC后的平均住院时间为9.00±2.91天，明显短于BHC后的平均住院时间（14.75±5.95天）。在40名患者的总样本中，较长的LOS与出院后复发相关的二次手术风险较高。 TDC组术后3个月mRS评分的变化值及其与术前评分的比值与BHC组有显着差异，提示TDC后神经功能的改善明显大于BHC组。在BHC之后。尽管TDC组的18例患者（90％）治愈了，但是与BHC组的治愈率没有显着差异[15例患者（75％）]。总之，两种手术治疗后CSDH患者的治愈率和死亡率均无明显差异。然而，与BHC组相比，术后3个月TDC组的mRS评分有明显改善，并且TDC组的总LOS明显短于BHC组。因此，在CSDH的治疗中，TDC优于BHC（注册号为ChiCTR-INR-16008368）。

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