去骨瓣减压行数字化塑形钛网缺损颅骨修补术后继发硬膜外积液的危险因素分析

Analysis of risk factors of secondary epidural effusion after cranioplasty with digital shaping titanium mesh by decompression with bone flap removal

目的分析去骨瓣减压行数字化塑形钛网缺损颅骨修补术后继发硬膜外积液的危险因素。方法回顾性分析本院神经外科2015年5月至2020年5月收治的67例行颅脑损伤去骨瓣减压后行颅骨修补术患者的临床资料,其中男47例,女20例,年龄(33.4±10.3)岁。依据颅骨修补术后是否继发硬膜外积液分为硬膜外积液(+)组(有积液)和硬膜外积液(-)组(无积液)。统计术后硬膜外积液的发生情况,并采用单因素及多因素logistic回归分析术后继发硬膜外积液的危险因素。结果67例患者均顺利完成颅骨修补手术,其中20例(29.9%)患者术后经头颅CT检查证实硬膜外积液;其中15例接受保守治疗,4例经皮下钛网外放置引流管,1例去除钛网清除积液,随访复查积液均减少或消失;单因素分析初步筛选出4个(颅骨缺损面积、硬脑膜缺损、硬脑膜钙化、硬膜外积气)与颅骨修补术后继发硬膜外积液有关的危险因素;多因素logistic回归分析结果显示颅骨缺损面积(OR=7.498,95%CI=1.192~47.180,P=0.032)、硬脑膜钙化(OR=13.543,95%CI=1.140~160.875,P=0.039)、硬膜外积气(OR=9.137,95%CI=2.462~33.908,P=0.001)均为最终影响颅骨修补术后继发硬膜外积液的危险因素。结论颅骨修补术后硬膜外积液的发生率较高,影响术后硬膜外积液发生的危险因素有颅骨缺损面积、硬脑膜钙化、硬膜外积气等。

Objective To analyze the risk factors of secondary epidural effusion after cranioplasty with digital shaping titanium mesh by decompression with bone flap removal.Methods Retrospective analysiswas performed on the clinical data of 67 patientswith craniocerebral injury who underwent cranioplasty after decompression with bone flap removal in the Department of Neurosurgery of our hospital fromMay 2015 toMay 2020,including 47males,20 females,aged(33.4±10.3).They were divided into epidural effusion(+)group(with effusion)and epidural effusion(-)group(without effusion)according to whether there was secondary epidural effusion after cranioplasty.The incidence of postoperative epidural effusion was calculated,and the risk factors of postoperative secondary epidural effusion were analyzed by univariate and multivariate logistic regression analysis.Results All the 67 patients successfully completed cranioplasty,20 of them had epidural effusion confirmed by cranial CT examination after operation,with the incidence of 29.9%.Among them,15 cases received conservative treatment,4 cases had a drainage tube placed outside the subcutaneous titanium mesh,1 case had titanium mesh removed to remove the effusion,and the effusion decreased or disappeared during follow-up review.Four risk factors(skull defect area,dura defect,dura calcification,epidural gas)related to secondary epidural effusion after cranioplasty were preliminarily screened by univariate analysis;multivariate logistic regression analysis showed that the area of skull defect(OR=7.498,95%CI=1.192~47.180,P=0.032),dura calcification(OR=13.543,95%CI=1.140~160.875,P=0.039),and epidural gas(OR=9.137,95%CI=2.462~33.908,P=0.001)were the risk factors of secondary epidural effusion after cranioplasty.Conclusion The incidence of epidural effusion after cranioplasty is relatively high,and the risk factors affecting the occurrence of epidural effusion after cranioplasty include the area of skull defect,dura calcification,epidural gas,etc.