| Objective: To study the basal ganglia of hypertension patients withintracerebral hemorrhage methods and clinical effects of surgical treatmentare discussed.Methods: A retrospective analysis of our hospital from January2009toDecember2012admission diagnosis of hypertensive basal gangliahemorrhage are line traditional craniotomy surgery patients as a controlgroup, shall be the standard the temporal top of the horseshoe-shapedincision craniotomy, according to the location of the hematoma select thesuperior temporal gyrus or middle temporal gyrus cortex approach, thenaked eye or under a microscope to completely remove the hematoma,double-click the coagulation bleeding, the gelatin sponge oppressioncompletely stop the bleeding, hematoma cavity drainage tube, tight duralclosure and the edge of the bone window suspension dura, skull flap resetlock fixed or decompressive craniectomy intracranial pressure, Review ofhead CT within24hours after surgery. Be the line of small bone window craniotomy temporal bait approach surgery patients as the experimentalgroup, the use of small bone window craniotomy patients after the CTlocalization to be from the cerebral cortex nearest small bone windowcraniotomy, the temporal hooked into the road, under a microscope theelimination of hematoma, double-click the coagulation bleeding, gelatinsponge oppression completely stop the bleeding, hematoma cavity drainagetube and slowly and continuously during off cranial saline flush, tight duralclosure, the bone window edge drilling suspension dura, bone flap resetskull lock, within24hours after review of head CT, and defuse the situationaccording to the patient 's awareness, muscle strength, language and othersymptoms, bleeding, hospitalization time, the circumstances of the deathare statistics.Results:1. small bone window hematoma evacuation rate mean of96.88%, can be up to99%of the rate of hematoma, the large craniotomyhematoma mean rate of87.96%, the largest hematoma rate of93%, F=73.836, P=0.000<0.01, a group of small bone window with largecraniectomy hematoma rates were significantly different under themicroscope of small bone window craniotomy hematoma larger craniotomymore thorough.2.Small bone window units in67cases bleeding in3cases,accounting for4.478%the craniectomy group of25patients in bleeding in1case,4%, independent samples t-test F=0.039, P=0.921>0.05, twosurgical way rebleeding rate was no significant difference, the small bone window craniotomy does not increase the risk of rebleeding.3. small bonewindow craniotomy patients with67cases and11deaths, a mortality rate of16.42%, the large craniotomy patients with25deaths in eight cases, themortality rate of32%, a small bone window craniotomy significantlyreduced mortality trends, but the two surgical mortality was no significantdifference (F=2.719, P=0.103>0.05), suggesting that large the craniotomysurgery does not increase mortality risk compared to small bone windowcraniotomy.4.Large trauma craniotomy patients with muscle recoveryinvalid68%, efficiency32%,4%were cured, significant improvement of24%, an improvement of4%, small bone window craniotomy patients withmuscle recovery invalid53.73%efficiency of46.27%, cure19.40%,significantly higher than craniotomy cure rate significantly improved to19.40%, an improvement of7.463%, suggesting that small bone windowcraniotomy due to less damage to muscle recovery will certainly help, butno statistically significant (P=0.508182>0.05).5.large trauma craniotomy patient awareness recovery is invalid oraggravate deaths accounted for48%,52%efficiency, slightly improved in28%, an improvement of4%, a significant improvement in12%cure8%.Small bone window craniotomy patients consciousness recovery invalid oraggravate deaths accounted for41.8%,58.2%efficiency, which improvedslightly to14.93%, an improvement of19.40%,4.478%significantlyimproved the cure19.40%. Prompted small bone window craniotomy can increase the awareness of patients resume normal cure rate trends, the totalefficiency is increased compared with the control group, but failed to reachstatistical significance P=0.995285>0.05, no statistically significant.Influencing factors in patients admitted to hospital awareness of the situationof patient awareness prognosis were significantly different (P=0.000128<0.05) was statistically significant, suggesting that the better: the awarenessof patients admitted to hospital, the better the prognosis of patients.6. largetrauma craniotomy control group68%efficiency,32%efficiency, whichimproved16%, significantly improved4%, the cure rate was12%. Smallbone window craniotomy experimental group efficiency of43.28%,56.72%efficiency, which improved by29.85%,20.90%significantly improved,the cure rate was5.970%. Prompted small bone window craniotomyimprove language recovery efficiency is significantly improved patients hasimproved greatly, but failed to achieve a statistically significant difference(P=0.251731>0.05), bleeding sites on the prognosis of patients withlanguage in the influencing factors a significant difference (P=0.000344<0.05), prompted the left hemispheric dominance of bleeding in patients withlanguage and poor prognosis, the opposite right side of the non-dominanthemisphere hemorrhage language better prognosis. The impact of hospitalstay for patients language prognosis were significantly different (P=0,0073073<0.05), the prompt hospitalization longer the language betterprognosis. Conclusion:By randomly using two different surgical methods in thetreatment of hypertensive cerebral hemorrhage, no significant difference inthe recovery of consciousness of patients, muscle strength, languagebetween the two groups was not statistically significant, but small bonewindow craniotomy temporal bait approach has average length of stay isrelatively short, the cost is relatively small, open under a microscope toremove the hematoma, the patient suffered trauma, surgery time wassignificantly reduced the hematoma more thoroughly, no significantincrease in bleeding risk, reduce mortality, improve emergency treatmentsuccess rate trends, muscle strength, consciousness, language and otherimportant functions to restore the good trend, fewer complications, etc.,can be used as conventional surgery of hypertensive intracerebralhemorrhage minimally invasive treatment. |
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