数字化钛网颅骨成形术后颅内血肿的相关临床因素分析

A retrospective clinical analysis of intracranial hemorrhage after digital shaped titanium mesh cranioplasty

目的:为减少颅骨成形术后颅内血肿的发生率提供临床依据。方法:通过对212例颅骨成形术后临床数据的研究,将各项相关因素与术后颅内血肿进行单因素及多因素分析。结果:术后血肿形成18例(8.5%),其中单纯硬膜外血肿为12例,经保守治疗均治愈;硬膜外血肿合并脑内血肿3例,2例经保守治疗后痊愈,1例行"开颅血肿清除+钛板复位术"后痊愈;脑内血肿并破入脑室1例,予以脑室外引流+血肿穿刺引流后痊愈;单纯脑内出血1例,予以保守治疗后痊愈;硬膜外/下血肿1例,患者术后出现脑肿胀,家属放弃治疗后死亡。术前各项相关因素与术后颅内血肿形成无显著相关性。结论:术前各项相关因素与术后颅内血肿形成无显著相关性。引起颅内新发血肿的主要因素可能在于手术具体操作及术后围手术处理。

Objective:Two hundred and twelve digital shaped titanium mesh cranioplasties were performed at the authors’institution.By the research for these cranioplasties postoperative hemorrhage complication.we hope to provide evidence of evidence-based medicine reducing postoperative intracranial hemorrhage.Methods:All patients after digital shaped titanium mesh cranioplasty were analyzed retrospectively,each parameters were evaluated with univariate and multivariate analysis.Results:Postoperative intracranial hematoma was found in 18 cases(8.5%),including 12 cases of pure epidural hematoma.All cases were cured after treatment.Epidural hematoma combined with intracerebral hematoma was found in 3 cases:two cases were cured after conservative treatment,and 1 case was cured after clearance of intracerebral hematoma and titanium plate reduction.Hypertensive cerebral hemorrhage and breaking into ventricle was found in one case:the case was cured after cerebrospinal fluid drainage and brain hematoma puncture drainage.Simple intracerebral hemorrhage was found in 1 case and was cured after conservative treatment.Epidural hematoma combined with subdural hematoma was found in 1 case:the patient suffered postoperative brain swelling,and his family members gave up treatment and died.Postoperative intracranial hemorrhage was not related with any preoperative factors.Conclusion:Postoperative intracranial hemorrhage was not related with the preoperative factors of patients themselves and the professional title of the surgeon.The main cause of new postoperative intracranial hematoma may be the specific operation and postoperative perioperative management.