颞肌下颅骨修补术中硬膜破损危险因素分析

Risk Factors Analysis of Duradamage in Subtemporal Cranioplasty

目的探讨颞肌下颅骨修补术中硬膜破损的危险因素。方法回顾分析2013年6月至2018年6月106例颞肌下颅骨修补患者的病历资料,对其中32例术中硬膜破损的病例,从颅骨缺损范围,去骨瓣到修补时间,上次手术硬膜是否修补,骨窗部脑组织凹陷程度,修补前颞肌是否萎缩几方面,应用检验分析硬膜破损的危险因素。结果颞肌下颅骨修补硬膜破损发生机率为30.2%,颅骨缺损面积大,去骨瓣术时硬膜未修补是硬膜破损的危险因素(P<0.05)。结论第1次手术硬膜敞开,颅骨缺损面积较大是分离肌皮瓣时硬膜破损的危险因素。颅骨修补前要了解上次手术情况,对上次手术未做硬膜修补,颅骨缺损面积大者术中要留薄层颞肌在硬膜表面是避免硬膜破损的策略。

Objective To analyze the clinical data of patients undergoing subtemporal cranioplasty and evaluate the risk factors of duradamage. Methods Clinical data of 106 patients underwent subtemporal cranioplasty from June 2013 to June 2018 were analyzed. Time between cranioplasty, size of bone flap,depressed skull defects,temporal muscular atrophy,duramater opening in the first operation were analyzed as influencing factors in 32 out of 106 cases. Chi-square test was used to select risk factors for duradamage. Results The incidence of duradamage in subtemporal cranioplasty was 30.2%. Size of bone flap, duramater opening in the first operation were risk factors of duradamage. Conclusion Large sizes of bone flap and duramater opening in the first operation are risk factors of duradamage. Prior to cranioplasty,it is necessary to understand the previous operation. In the case of large cranioplasty without dural repair,leaving a thin layer of temporalis muscle on the dural surface is a strategy to avoid the rupture of the dural.