Therapeutic efficacy of a novel simple manual bone cone drilling hematoma drainage for hypertensive intracerebral hemorrhage

doi:10.3969/j.issn.1672-6731.2024.06.008

Abstract

Abstract:

Objective: To explore the efficacy of a novel and hematoma drainage for hypertensive intracerebral hemorrhage. Methods: From January 2021 to December 2022, 103 patients with hypertensive intracerebral hemorrhage at The Affiliated Bozhou Hospital of Anhui Medical University were included. They were treated with traditional bone cone drilling hematoma drainage (traditional group, n = 51) and novel-type bone cone drilling hematoma drainage (novel-type group, n = 52). Based on pre- and post-surgery head CT results, the hematoma clearance rate and accuracy of catheter placement were calculated. National Institutes of Health Stroke Scale (NIHSS) was used to assess the severity of neurological deficits, and modified Rankin Scale (mRS) was used to evaluate the neurological functional prognosis. Results: The hematoma clearance rate in the novel-type group [(45.54 ±24.23)% vs. (35.08 ±6.49)%; t = 3.008, P = 0.004] and the accuracy of catheter placement [90.38% (47/52) vs. 68.63% (35/51); χ² = 7.509, P = 0.006] were significantly higher than those of the traditional group. The novel-type group and the traditional group showed statistically significant differences in hematoma volume (F = 9.157, P = 0.003) and mRS score (F = 4.412, P = 0.038). The postoperative hematoma volume (t =-4.625, P = 0.000) and mRS score (t =-2.712, P = 0.008) of the novel-type group were lower than those of the traditional group. Statistically significant differences were observed in hematoma volume (F = 280.635, P = 0.000), NIHSS score (F = 443.320, P = 0.000) and mRS score (F = 552.781, P = 0.000) before and after surgery in the 2 groups; the hematoma volume (t = 10.233, P = 0.000; t = 19.906, P = 0.000), NIHSS score (t = 14.576, P = 0.000; t = 15.286, P = 0.000) and mRS score (t = 20.201, P = 0.000; t = 13.511, P = 0.000) after operation were lower than those before operation in the 2 groups. Conclusions: The novel and simple manual bone cone drilling hematoma drainage is a safe and effective treatment for hypertensive intracerebral hemorrhage.

Key words: Intracranial hemorrhage, hypertensive, Hematoma, Drainage, Tomography, spiral computed, Neurosurgical procedures

摘要：

目的: 探讨新型简易徒手锥颅血肿引流术治疗高血压脑出血的疗效。方法: 共纳入2021年1月至2022年12月安徽医科大学附属亳州医院收治的103例高血压脑出血患者，分别行传统锥颅血肿引流术（传统锥颅组，51例）和新型锥颅血肿引流术（新型锥颅组，52例）。根据手术前后头部CT图像计算血肿清除率，评价引流管置入精准度；采用美国国立卫生研究院卒中量表（NIHSS）评价神经功能缺损程度，改良Rankin量表（mRS）评价神经功能预后。结果: 新型锥颅组血肿清除率[（45.54 ±24.23）%对（35.08 ±6.49）%；t = 3.008，P = 0.004]和引流管置入精准度[90.38%（47/52）对68.63%（35/51）；χ² = 7.509，P = 0.006]均高于传统锥颅组。新型锥颅组与传统锥颅组血肿量（F = 9.157，P = 0.003）和mRS评分（F = 4.412，P = 0.038）差异具有统计学意义，术后新型锥颅组血肿量（t = - 4.625，P = 0.000）和mRS评分（t = - 2.712，P = 0.008）均低于传统锥颅组；两组手术前后血肿量（F = 280.635，P = 0.000）、NIHSS评分（F = 443.320，P = 0.000）和mRS评分（F = 552.781，P = 0.000）差异亦具有统计学意义，新型锥颅组和传统锥颅组术后血肿量（t = 10.233，P = 0.000；t = 19.906，P = 0.000）、NIHSS评分（t = 14.576，P = 0.000；t =15.286，P = 0.000）和mRS评分（t = 20.201，P = 0.000；t = 13.511，P = 0.000）均低于术前。结论: 新型简易徒手锥颅血肿引流术治疗高血压脑出血安全、有效。

关键词: 颅内出血, 高血压性, 血肿, 引流术, 体层摄影术, 螺旋计算机, 神经外科手术

Ruo-dong HAN, Ya-fei ZHANG, Xiu-xia YAN, Bo-wen LI, Bei-li QIAN. Therapeutic efficacy of a novel simple manual bone cone drilling hematoma drainage for hypertensive intracerebral hemorrhage[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2024, 24(6): 461-470.

韩若东, 张亚飞, 颜秀侠, 李博文, 钱贝丽. 新型简易徒手锥颅血肿引流术治疗高血压脑出血疗效分析[J]. 中国现代神经疾病杂志, 2024, 24(6): 461-470.

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URL: https://journal11.magtechjournal.com/cjcnn/EN/10.3969/j.issn.1672-6731.2024.06.008

https://journal11.magtechjournal.com/cjcnn/EN/Y2024/V24/I6/461

Figures/Tables 8

Table 1. Comparison of general information between the novel-type group and the traditional group

观察指标	传统锥颅组（n = 51）	新型锥颅组（n = 52）	统计量值	P值
性别[例（%）]			2.390	0.122
男性	31（60.78）	39（75.00）
女性	20（39.22）	13（25.00）
年龄（${\bar x}$ ± s，岁）	63.24 ± 13.68	62.56 ± 14.08	0.248	0.805
发病至手术时间 [M（P₂₅，P₇₅），h]	6.00 （4.00，10.00）	6.00 （4.00，7.00）	- 0.837	0.383
高血压[例（%）]	42（82.35）	39（75.00）	0.829	0.363
冠心病[例（%）]	9（17.65）	12（23.08）	0.468	0.494
糖尿病[例（%）]	6（11.76）	10（19.23）	1.094	0.296
高血脂症[例（%）]	10（19.61）	11（21.15）	0.038	0.846
吸烟[例（%）]	29（56.86）	27（51.92）	0.253	0.615
饮酒[例（%）]	23（45.10）	26（50.00）	0.248	0.618
入院时GCS（${\bar x}$ ± s，评分）	9.12 ± 2.17	9.92 ± 2.60	1.704	0.091
收缩压（${\bar x}$ ± s，mm Hg）	172.14 ± 20.04	165.79 ± 15.79	1.784	0.078
舒张压（${\bar x}$ ± s，mm Hg）	92.43 ± 8.44	95.63 ± 9.87	1.768	0.080
出血部位[例（%）]			- 0.482	0.630
基底节区	39（76.47）	41（78.85）
丘脑	7（13.73）	10（19.23）
脑叶	5（9.80）	1（1.92）
血肿量（${\bar x}$ ± s，ml）	28.77 ± 8.80	26.30 ± 8.70	- 1.433	0.155

Figure 1 The largest section of hematoma was located in novel-type bone cone drilling hematoma drainage. The 3 electrode patches were applied to 1.50-2.00 cm above the tips of both ears and 5-6 cm above the inner canthus (Panel 1a). The largest section of the hematoma was selected on the CT image (Panel 1b). The largest section of the hematoma was located using a CT scanner (cursor lines indicate, Panel 1c). The bilateral body surface projection at the largest section of the hematoma on the scalp surface was delineatd according to the cursor line (arrow indicates, Panel 1d).

Figure 2 Diagram of novel-type bone cone drilling hematoma drainage Each point was located on the largest section of the hematoma before transfrontal bone cone drilling for hematoma drainage (point A was the intersection of the extension line of CD and the extension line of sagittal line, point B was the intersection of sagittal line and frontal bone, point C was the intersection of the puncture direction line passing through point D and frontal bone, point D was the puncture target, level M was the maximum puncture level of the hematoma; Panel 2a). The scalp position corresponding to each mark in the actual operation of the transfrontal bone cone drilling (Panel 2b). During the operation, the laser pen was used to assist the overlap of the ABC plane and the largest section of the hematoma (Panel 2c). Each point was located on the largest section of the hematoma before temporal bone cone drilling for hematoma drainage (point A was the intersection of the puncture direction line passing through point D and the right temporal bone, point B was the intersection of the puncture direction line passing through point D and the left temporal bone, point C was the intersection of the sagittal line and the frontal bone, point D was the puncture target, level M was the maximum puncture level of the hematoma; Panel 2d).

Figure 3 Diagram of traditional bone cone drilling hematoma drainage.

Table 2. Comparison of hematoma volume, NIHSS and mRS scores between the novel - type group and the traditional group before and after surgery (${\bar x}$ ± s)

组别	例数	术前	术后
血肿量（ml）
传统锥颅组	51	28.77 ± 8.80	18.67 ± 6.09
新型锥颅组	52	26.30 ± 8.70	13.26 ± 5.77
NIHSS（评分）
传统锥颅组	51	22.12 ± 3.83	4.06 ± 2.34
新型锥颅组	52	22.85 ± 5.07	4.08 ± 2.46
mRS（评分）
传统锥颅组	51	4.88 ± 1.42	2.86 ± 1.08
新型锥颅组	52	4.98 ± 1.75	2.33 ± 1.06

Table 3. Premeasure - postmeasure design of ANOVA of hematoma volume, NIHSS and mRS scores between the novel - type group and the traditional group before and after surgery

变异来源	SS	df	MS	F值	P值
血肿量
处理因素	798.876	1	798.876	9.157	0.003
测量时间	6 887.288	1	6 887.288	280.635	0.000
处理因素×测量时间	110.946	1	110.946	4.521	0.036
组间误差	8 811.825	101	87.246
组内误差	2 478.723	101	24.542
NIHSS
处理因素	7.176	1	7.176	0.164	0.686
测量时间	17 460.788	1	17 460.788	443.320	0.000
处理因素×测量时间	6.497	1	6.497	0.165	0.685
组间误差	4 416.552	101	43.728
组内误差	3 978.027	101	39.386
mRS
处理因素	2.463	1	2.463	4.412	0.038
测量时间	281.179	1	281.179	552.781	0.000
处理因素×测量时间	5.179	1	5.179	10.181	0.002
组间误差	56.382	101	0.558
组内误差	51.375	101	0.509

Table 4. Pairwise comparison of hematoma volume and mRS score between the novel - type group and the traditional group at the same time point

组间两两比	血肿量		mRS
组间两两比	t值	P值	t值	P值
术前	- 1.433	0.155	1.990	0.051
术后	- 4.625	0.000	- 2.712	0.008

Table 5. Pairwise comparison of hematoma volume, NIHSS and mRS scores before and after surgery at the same group

组内两两比	血肿量		NIHSS		mRS
组内两两比	t值	P值	t值	P值	t值	P值
传统锥颅组	19.906	0.000	15.286	0.000	13.511	0.000
新型锥颅组	10.233	0.000	14.576	0.000	20.201	0.000

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