Brighton and Sussex Medical School, BSMS Teaching Building, University of Sussex, Brighton, East Sussex BN1 9PX, United Kingdom.
Int J Surg. 2012;10(9):450-2. doi: 10.1016/j.ijsu.2012.08.005. Epub 2012 Aug 20.
A best evidence topic in neurosurgery was written according to a structured protocol. The question addressed was: In patients undergoing craniostomy for the evacuation of chronic subdural haematoma, does the use of two burr-holes compared to one burr-hole improve clinical outcomes? A total of 238 papers were identified using the reported search protocol. Four of these articles represented the best evidence to answer the clinical question. The authors, date and country of publication, study type, patient group, outcomes and key results of these papers have been represented in a table. Three out of four studies showed that there was no significant difference in prevalence or rate of haematoma recurrence between two burr-hole craniostomy or one burr-hole craniostomy. Two studies demonstrated shorter hospital stay with two burr-hole craniostomy. Furthermore, one study showed increased rates of wound infection with one burr-hole craniostomy. Therefore, the clinical bottom line is that performing either two burr-hole craniostomy or one burr-hole craniostomy does not provide specific differences in patient outcome improvement following surgery for chronic subdural haematoma, however further research is required owing to the flawed methodology of existing studies.
按照既定的结构化方案，我们撰写了一篇神经外科最佳证据主题。问题如下：在接受颅骨切开术以清除慢性硬脑膜下血肿的患者中，与单一切口相比，双切口是否能改善临床结局？通过报告的搜索方案，共确定了 238 篇论文。其中 4 篇文章提供了回答临床问题的最佳证据。这些文章的作者、日期和国家/地区、研究类型、患者群体、结局以及关键结果都在一个表格中列出。4 项研究中有 3 项表明，双切口颅骨切开术与单一切口颅骨切开术相比，血肿复发的发生率或复发率没有显著差异。两项研究表明，双切口颅骨切开术的住院时间更短。此外，一项研究表明，单一切口颅骨切开术的伤口感染率更高。因此，临床底线是，对于慢性硬脑膜下血肿的手术治疗，行双切口颅骨切开术或单一切口颅骨切开术并不能显著改善患者的预后，但由于现有研究方法存在缺陷，还需要进一步研究。
