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Objective·To analyse the relating factors that influence the prognosis of chronic subdural hematoma(CSDH) after drilling drainage and to explore the bilateral bleeding risk factors of CSDH.Methods·Four hundred and forty patients with CSDH who underwent drilling drainage were retrospectively analysed.Clinical data,including medical history,signs,blood coagulation function and imaging examination were collected.Spearman correlation analysis and ordinal Logistic regression analysis were performed to assess the relationships between various variables and the prognosis,and univariate analysis and multivariate Logistic regression analysis were performed to explore the risk factors that lead to the occurrence of bilateral bleeding.Results·Spearman correlation analysis indicated that age,medication history of anticoagulant drugs,bilateral hematoma or not,the thickness of the hematoma and volume of intracranial gas on the first post-surgery day and preoperative Markwalder grade were associated with postoperative Markwalder grade (P＜0.05).Ordinal Logistic regression analysis showed that medication history of anticoagulant drugs and preoperative Markwalder grade were the independent risk factors (P=0.028,P=0.000).Univariate analysis of the bilateral bleeding indicated that age,medication history of anticoagulant drugs and thrombin time were statistically different between unilateral and bilateral CSDH (P＜0.05).Multivariate Logistic regression analysis revealed that thrombin time was the independent risk factor (OR=1.147,95％CI1.005-1.309,P=0.042).Conclusion·Age and medication history of anticoagulant drugs were closely related to the bilateral chronic subdural hematoma.The higher the preoperative Markwalder grade is,the higher the postoperative Markwalder grade is.The prognosis of patients without anticoagulant drugs is better than those users.
ABSTRACT
Objective·To study the application of occipitocervical fusion and fixation in malformation of craniocervical junction surgery.Methods·Thirty-six consecutive patients with craniocervical junction malformation were decompressed under evoked-potential monitoring.Sixteen patients were treated with posterior occipitocervical fusion and fixation using Vertex screw-hook system,and 11 using Vertex screw-rod system,other patients using Mountaineer OCT spinal system.All patients were followed up for 2 to 12 years (mean 7 years).The recovery rate was analysed based on the scoring system of the Japanese Orthopaedic Association (JOA).Results·All the patients were followed up.A stable bony fusion according to radiological criteria was achieved in all cases.There was no implant broken and dislocation.The improvement rate according to JOA scoring system were evaluated.Twenty-four cases (66.7％) got cured;4 cases (11.1％) had remarkable effects;8 cases (22.2％) were effective;none was ineffective.Conclusion·Occipitocervical stabilizations hope to be restored through occipitocervical fusion and fixation.Good results can be obtained in most patients with complete radiological data,proper surgery indication,suitable surgical modality and internal fixation materials.
ABSTRACT
<p><b>OBJECTIVE</b>To determine the effect of arousal methods for prolonged coma of 175 patients with severe traumatic brain injury and related factors.</p><p><b>METHODS</b>There were 175 cases with persistent coma longer than 1 month after severe traumatic brain injury. Coma lasted 1-12 months. Arousal procedures included hyperbaric oxygen, physical therapy and arousal drugs.</p><p><b>RESULTS</b>In the 175 prolonged coma patients 110 got recovery of consciousness; in 118 cases with coma of 1-3 months, 86 cases recovered consciousness (72.9%); in 42 cases with coma of 4-6 months, 20 cases recovered consciousness (47.6); and in 15 cases with coma of longer than 6 months, only 4 cases recovered consciousness (26.7%). The recovery of consciousness depended on patient's primary brain stem damage, cerebral hernia, GCS score, and age.</p><p><b>CONCLUSIONS</b>Application of appropriate arousal procedures improves recovery of consciousness in patients with prolonged coma.</p>