天津医药

天津医药 ›› 2026, Vol. 54 ›› Issue (5): 473-477.doi: 10.11958/20253058

• 临床研究 • 上一篇    下一篇

小骨窗开颅术与传统大骨瓣开颅术治疗中老年自发性脑出血患者的临床疗效比较

王雪岩1(), 尚葛础2△(), 王冠1, 王会乐2, 张启杨1   

  1. 1 天津中医药大学第二附属医院神经外科（邮编 300151）
    2 天津中医药大学研究生院
  • 收稿日期:2025-09-29 修回日期:2026-02-05 出版日期:2026-05-15 发布日期:2026-05-13
  • 通讯作者: △E-mail：1378834511@qq.com
  • 作者简介:王雪岩（1988），男，主治医师，主要从事神经外科中西医结合临床方面研究。E-mail：zyefwxy@163.com
  • 基金资助:
    天津市卫生健康委员会中医中西医结合科研课题(2023026)

Comparison of the clinical efficacy between limited craniotomy and standard decompressive craniectomy in the treatment of middle-aged and elderly patients with spontaneous cerebral hemorrhage

WANG Xueyan1(), SHANG Gechu2△(), WANG Guan1, WANG Huile2, ZHANG Qiyang1   

  1. 1 Department of Neurosurgery, the Second Affiliated Hospital of Tianjin University of TCM, Tianjin 300151, China
    2 Graduate School of Tianjin University of Traditional Chinese Medicine
  • Received:2025-09-29 Revised:2026-02-05 Published:2026-05-15 Online:2026-05-13
  • Contact: △E-mail：1378834511@qq.com

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摘要：

目的 探讨小骨窗开颅术与传统大骨瓣开颅术治疗中老年自发性脑出血（SICH）患者在围手术期指标、炎症反应及神经功能预后方面的差异。方法 选取133例中老年SICH患者，经倾向性评分匹配后纳入94例，根据手术方法不同分为小骨窗组（47例）和大骨瓣组（47例）。比较2组的基线资料（性别、年龄、吸烟史、饮酒史，高血压、糖尿病、脑血管病及冠心病病史）；手术相关指标（手术时间、住院时间、术后发热天数）；术后1、3、7 d C反应蛋白（CRP）、降钙素原（PCT）、白细胞计数（WBC）；术前、术后血肿量，血肿清除率；入院及术后1、3、7、14 d的格拉斯哥昏迷评分（GCS）：术后90 d病死率及术后90 d的改良Rankin量表评分（mRS）。结果 2组患者的年龄、性别、吸烟史、饮酒史、高血压史、糖尿病史、脑血管病史及冠心病史，住院天数及术后发热天数、WBC，术前、术后血肿量和血肿清除率、GCS、90 d mRS分布、90 d累积生存率差异均无统计学意义（均P>0.05）。小骨窗组手术时间短于大骨瓣组，术后3 d的CRP、PCT水平低于大骨瓣组（P<0.01）。结论 小骨窗开颅术治疗中老年SICH可获得与大骨瓣减压术相当的远期预后，并具有手术时间更短、术后炎症反应更轻的优势。

关键词: 脑出血, 血肿, C反应蛋白质, 中老年, 小骨窗开颅术, 大骨瓣减压术, 神经炎症反应

Abstract:

Objective To explore the differences of perioperative indicators, inflammatory response and neurological prognosis between small bone window craniotomy and traditional large bone flap craniotomy in middle-aged and elderly patients with spontaneous intracerebral hemorrhage (SICH). Methods A total of 133 middle-aged and elderly SICH patients were selected and 94 were included after propensity score matching. Patients were divided into the small bone window group (47 cases) and the large bone flap group (47 cases) according to the surgical methods. The baseline data (gender, age, smoking history, drinking history, history of hypertension, diabetes, cerebrovascular disease and coronary heart disease), surgical related indicators (operation time, hospital stay and postoperative fever days), C-reactive protein (CRP), procalcitonin (PCT), white blood cell count (WBC) on postoperative 1, 3 and 7 days, preoperative and postoperative hematoma volume and hematoma clearance rate, Glasgow Coma Scale (GCS), 90-day mortality and modified Rankin Scale (mRS) were compared on admission and postoperative 1, 3, 7 and 14 days between the two groups. Results There were no statistically significant differences in age, gender, smoking history, drinking history, history of hypertension, diabetes, cerebrovascular disease and coronary heart disease, hospital stay, postoperative fever days, WBC, preoperative and postoperative hematoma volume and hematoma clearance rate, GCS score, 90-day mRS score distribution and 90-day cumulative survival rate between the two groups. The operation time of the small bone window group was shorter than that of the large bone flap group, and the CRP and PCT levels on postoperative 3 days were lower than those of the large bone flap group (P<0.01). Conclusion Small bone window craniotomy for middle-aged and elderly patients with SICH can achieve a comparable long-term prognosis compared to that of large bone flap decompression, and it has the advantages of shorter operation time and milder postoperative inflammatory response.

Key words: cerebral hemorrhage, hematoma, C-reactive protein, middle-aged, limited craniotomy, decompressive craniectomy, neuroinflammation

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