颅骨修补感染的风险因素分析

Risk factors affecting surgical site infection after cranioplasty

目的 探讨去骨瓣减压术后颅骨修补感染的潜在风险因素。方法选取自2009年1月至2015年6月浙江大学丽水医院神经外科收治的行去骨瓣减压术后颅骨修补的319例患者的资料进行分析，使用Logistic回归模型分析感染的相关风险因素。结果 出现颅骨修补感染11例（3.4%）。Logistic回归分析表明修补感染与去骨瓣减压术时颞肌切除（OR=20.21，95%CI：2.09~135.38 ，P=0.003）、修补术前帽状腱膜下积液（OR=34.51，95%CI ：2.65~226.39 ，P=0.001）及修补手术持续时间大于150 min（OR=6.62, 95%CI： 0.96~37.43 ，P=0.044）密切相关，与患者的年龄、性别、去骨瓣减压原因及颅骨修补时机无关。结论去骨瓣减压术中切除颞肌、修补术前帽状腱膜下积液及修补手术时间大于150 min是颅骨修补感染的高风险因素。提高手术技巧以减少手术时间，去骨瓣减压术中尽量避免切除颞肌，严密缝合硬脑膜减少帽状腱膜下积液对预防颅骨修补感染十分重要。

Objective To identify the patient-specific and surgery-specific risk factors related to the development of surgical site cranioplasty infection after decompressive craniectomy. Methods A consecutive cohort of 319 patients who had undergone cranioplasty following decompressive craniectomy for stroke or trauma at a single institution from January 2009 to June 2015 was retrospectively established. Logistic regression analysis was performed to predict determinants related to infection following cranioplasty. Results Cranioplasty infection occurred in 11 patients （3.4%）. Logistic regression analysis identified that previous temporalis muscle resection （OR= 20.21, 95%CI： 2.09-135.38, P=0.003）, preoperative subgaleal fluid collection （OR=34.51, 95%CI： 2.65-226.39, P= 0.001）, and operative time （〉150 min） （OR= 6.62, 95%CI： 0.96-37.43, P=0.044） were significantly associated with the development of cranioplasty infection. Patient age, gender, indications forcraniectomy, and timeintervalbetween initial craniectomy and cranioplasty were not predictors of the development of cranioplasty infection. Conclusions Long surgical time （〉150 min）, presence of preoperative subgaleal fluid collection, and craniectomy with temporalis muscle resection may be risk factors for graft infection after cranioplasty. Surgical techniques should be developed to reduce operative time and avoid temporalis muscle resection when possible. In addition, meticulous dural closure aimed at reducing the formation of subgaleal fluid collection is important for the prevention of graft infections after cranioplasty.