颅骨修补术后咀嚼功能损害危险因素分析

Risk factors of masticatory dysfunction among patients undergoing cranioplasty

目的 探讨颅骨修补术后发生咀嚼功能损害的危险因素.方法 回顾性分析2008年1月至2012年12月解放军第三○九医院神经外科去骨瓣减压术后颅骨缺损行颅骨修补术112例患者的临床资料,将性别、年龄、颅骨缺损面积、颅骨缺损时间、手术方式等列为影响因素,采用咀嚼肌无力/疼痛视觉模拟评分评估术后1个月时的咀嚼功能.通过Pearson χ2检验筛选术后发生咀嚼功能损害的危险因素,经多因素Logistic回归分析确定独立危险因素.结果 术后1个月时发生咀嚼功能障碍43例（38.39％）.年龄＜ 40岁对术后1个月时发生咀嚼肌无力与未发生咀嚼肌无力比较[23.0％ （17/74）比77.0％ （57/74）],差异有统计学意义（χ2=5.625,P=0.018）;发生疼痛与未发生疼痛比较[24.3％ （18/74）比75.7％ （56/74）],差异有统计学意义（χ2=7.482,P=0.006）;颅骨缺损面积≥60 cm2对术后1个月时,发生咀嚼肌无力与未发生咀嚼肌无力比较[72.4％ （21/29）比27.6％ （8/29）],差异有统计学意义（χ2=32.739,P=0.000）,发生疼痛与未发生疼痛比较[69.0％（20/29）比31.0％ （9/29）],差异有统计学意义（χ2=22.836,P=0.000）;颅骨缺损时间≥1年术后1个月时,发生咀嚼肌无力与未发生咀嚼肌无力比较[86.7％ （26/30）比13.3％ （4/30）],差异有统计学意义（χ2=61.454,P=0.00）,发生疼痛与未发生疼痛比较[80.0％ （24/30）比20.0％（6/30）],差异有统计学意义（χ2 =40.854,P=0.00）.非条件Logistic回归多因素分析显示颅骨缺损面积和时间分别为术后1个月时发生咀嚼肌无力[颅骨缺损面积比值比（OR） =11.179,95％置信区间（CI）：2.572 ～48.582,P＜0.01）;颅骨缺损时间（OR =51.741,95％ CI：12.27 ～218.25,P＜0.01）]和疼痛[颅骨缺损面积（OR=3.921,95％CI：1.23～12.52,P＜0.05）;颅骨缺损时间（OR=14.388,95％CI：4.65 ～44.53,P＜0.01）]的独立危险因素.结论 去骨瓣减压术后早期行颅骨修补术有利于保护患者咀嚼功能,对于颅骨缺损面积大的患者术后应加强咀嚼功能锻炼.

Objective To evaluate risk factors of postoperative injury of masticatory function.Methods The clinical data of 112 cases undergoing cranioplasty for calvarial defects following decompressive craniotomy in the 309 hospital of PLA from January 2008 to December 2012 were analyzed retrospectively; gender,age,area of defect,duration of defect and surgical approach were analyzed as influencing factors.Masticatory function at one month after cranioplasty was evaluated by Visual Analogue Scale; Pearson Chi-square test was employed to select risk factors for masticatory dysfunction.Non-condition logistic regression analysis was employed to define the independent risk factors.Results There were 43 cases （38.4%） of postoperative masticatory dysfunction at one month following cranioplasty.Age 〈 40 years was significantly related to postoperative masticatory fatigue [yes 23.0% （17/74） versus no 77.0% （57/74）,χ2 =5.625,P =0.018] and pain [yes 24.3% （18/74） versus no 75.7 % （56/74）,χ2 =7.482,P =0.006].Area of defect ≥ 60 cm2 was significantly related to postoperative masticatory fatigue [yes 72.4% （21/29） versus no 27.6% （8/29）,χ2 =32.739,P =0.000] and pain [yes 69.0% （20/29） versus no 31.0% （9/29）,χ2 =22.836,P =0.000].Duration of defect ≥ 1 year was significantly related to postoperative masticatory fatigue [yes 86.7% （26/30） versus no 13.3 % （4/30）,χ2 =61.454,P =0.000] and pain [yes 80.0% （24/30） versus no 20.0% （6/30）,χ2 =40.854,P =0.000].Area and duration of defect were independent risk factors for patients suffering masticatory muscle fatigue [area of defect （OR =11.179,95% CI：2.572-48.582,P〈0.01） ; duration of defect （OR=51.741,95%CI：12.27-218.25,P〈0.01）] and pain [area of defect （OR =3.921,95% CI：1.23-12.52,P 〈 0.05） ; duration of defect （OR =14.388,95% CI：4.65-44.53,P 〈0.01）] respectively by non-condition Logistic regression analysis.Conclusions Early cranioplasty following decompressive craniotomy is helpful to protect patient＇s masticatory function.Attention should be paid to patients with large area of defect to enhance masticatory functional exercise postoperatively.