Application of twist drill craniostomy with urokinase in chronic subdual hematoma / 国际外科学杂志

ABSTRACT

Objective To evaluate the clinical effect of chronic subdual hematoma between surgical procedure twist drill craniostomy with injecting urokinase into hematoma space and only with twist drill craniostomy.Methods Two hundred and twenty-five patients with chronic subdual hematoma patients who were admitted in the Affiliated Hospital of Yangzhou University from January 2011 to April 2017 were retrospectively analyzed.They were divided into two groups according to the different surgical methods,group A for twist drill craniostomy with injecting urokinase into hematoma space (n =116),group B only for twist drill craniostomy (n =109).Then the postoperative drainage volume and residual hematoma was analyzed by repeated measures,while radiographic grading system and recurrence rates after operation were compared between groups with statistical analysis which was done by ANOVA analysis or non-parametric rank sum test.Results The drainage volume 48 hours after surgery was(52.41 ± 7.86) ml in group A,(28.42 ± 4.46) ml in group B as well.The residual volumes which were calculated at 1 month,3 months after surgery was (23.35 ±4.18) ml and (15.31 ±6.15) ml in group A,comparing the volumes of (46.07 ± 5.96) ml and (25.60 ± 5.03) ml in group B.The radiographic grading system was evaluated by grade 1-4.There were 75(64.7％) cases in grade 1,32(27.6％) cases in grade 2,8(6.9％) cases in grade 3,1 (0.9％) cases in grade 4 of group A,as well as 42(38.5％) cases in grade 1,55(50.5％) cases in grade 2,11 (10.1％) cases in grade 3,1 (0.9％) cases in grade 4 of group B.The rate of recurrence for chronic subdural hematoma was 6.0％ in group A,while it was 15.6％ in group B.These data all had significant statistical difference between the two groups (P ＜ 0.05).Conclusion Twist drill craniostomy might be a safe,effective and mini-massive method for treating chronic subdual hematoma,while injecting urokinase into the hematoma space could significantly reduce the rate of recurrence and decrease the volume of hematoma.