自体颅骨修补术后影响骨瓣吸收的危险因素分析

Analysis of risk factors for bone resorption after cranioplasty with autogenous bone flaps

目的探讨影响自体颅骨修补术后骨吸收的危险因素。方法回顾性分析2001年1月至2012年12月期间经临沂市人民医院神经外科行自体颅骨修补的患者178例,含201块自体骨瓣,根据术后CT特点对骨吸收进行分级,探讨各危险因素与骨吸收分级之间的关系。结果骨吸收分级在性别、修补时间和骨瓣面积间的差异无意义(P>0.05),患者平均年龄随骨吸收分级上升呈下降趋势,但骨吸收各分级间的平均年龄之间差异无意义(P>0.05)。骨吸收分级与缺损位置有关(P<0.05),重度骨吸收多发生于额颞部和颞部。伴有骨折的骨瓣重度骨吸收发生率高于骨瓣完整者(P<0.05)。伴发脑积水并行脑室-腹腔分流术的患者与未行脑室-腹腔分流术的患者相比,前者术后骨瓣塌陷的发生率高于后者(P<0.05)。结论自体颅骨修补术后骨吸收分级与患者性别、年龄、修补时间和骨瓣面积无关。骨吸收分级与缺损位置有关,重度骨吸收多发生于额颞部和颞部。伴有骨折的骨瓣重度骨吸收发生率高于骨瓣完整者。伴发脑积水并行脑室-腹腔分流术后容易发生骨瓣塌陷。

Objective To analyze the risk factors for bone resorption after cranioplasty with autogenous bone flaps. Methods A retrospective analysis was performed on the clinical data of 178 patients（ involving 201 autogenous bone flaps） with cranial defect who underwent cranioplasty with autogenous bone flaps in the Department of Neurosurgery in Linyi People＇s Hospital from January 2001 to December 2012. According to the postoperative computed tomography features,a bone flaps resorption grading was made to investigate the relationship of different risk factors with different grades of bone flap resorption. Results There were no significant difference in the grading of bone flap resorption between patients with different sexes,repair times,and sizes of bone flaps（ P〈0. 05）. The mean age of patients decreased with the increase in bone resorption grade. However,there was no significant difference in mean age between the different bone resorption grade groups（ P〈0. 05）. The bone resorption grade was correlated with the location of bone defect（ P〈0. 05） and the severe bone resorption always occurred in the temporal and frontotemporal regions. The autogenous bone flaps with fracture（ broken into 2 or 3 fragments） had a significantly higher incidence of severe bone resorption than those without fracture（ P〈0. 05）. For the patients with hydrocephalus,the patients who underwent the ventriculoperitoneal shunt had a significantly higher incidence of bone flap collapse than those who did not undergo the ventriculoperitoneal shunt（ P〈0. 05）. Conclusions The bone resorption grade after cranioplasty with autogenous bone flaps is not correlated with sex,age,repair time,and the size of bone flaps. The bone resorption grade is correlated with the location of bone defect,and severe bone resorption is commonly seen in the temporal and frontotemporal regions. The bone flaps with fracture have a higher incidence of severe bone resorption than those without fracture. The patients who undergo the ventriculoperitoneal shunt due to hydrocephalus are prone to having bone flaps collapse.