颅骨修补术后硬膜外积液形成的相关因素分析及处理对策

Analysis of related factors and treatment strategies of epidural fluid collection after cranioplasty

目的探讨颅骨修补术后硬膜外积液形成的相关因素及处理对策。方法收集自2012年1月至2021年1月淮南市第一人民医院神经外科收治的159例行颅骨修补患者病例资料,根据术后头颅CT动态复查明确有无硬膜外积液及其分型。通过单因素与多因素Logistic回归方法,分析患者性别、年龄、病程、术前GCS评分、高血压病史、糖尿病病史、颅骨缺损面积、骨窗凹陷深度、硬膜钙化、手术方式、术中出血量、术中硬膜破损、术后硬膜外积气、术后白蛋白水平、硬膜外引流方式等因素与硬膜外积液形成的关系。结果159例患者中52例术后出现硬膜外积液,占32.7%。单因素分析结果显示,颅骨缺损面积(≥75 cm3)、骨窗凹陷深度(≥1.5 cm)、硬膜外积气、硬膜钙化及术中硬膜破损是颅骨缺损修补术后硬膜外积液的危险因素(P<0.05)。多因素logistic回归分析示,骨窗凹陷深度、硬膜钙化及术中硬膜破损是颅骨修补术后硬膜外积液的独立危险因素(P<0.05)。结论对术前骨窗凹陷深度≥1.5 cm、存在硬膜钙化及术中硬膜破损的颅骨修补患者,硬膜外积液并发症的预防应贯穿整个围手术期。

Objective To investigate the related factors and treatment strategies of epidural fluid collection after cranioplasty.Methods The data of 159 patients undergoing cranioplasty who were admitted to the Department of Neurosurgery of Huainan First People’s Hospital from January 2012 to January 2021 were collected.According to the reexamination of the postoperative skull CT,the presence or absence of epidural fluid collection and its classification were determined..Through univariate and multivariate logistic regression methods,analyze the patient’s gender,age,course of disease,preoperative GCS score,history of hypertension,history of diabetes,skull defect area,depth of bone window depression,dural calcification,surgical method,and intraoperative blood loss The relationship between factors such as intraoperative dural damage,postoperative epidural air,postoperative albumin level,and epidural drainage methods and the formation of epidural fluid collection.Results 52 of 159 patients had epidural fluid collection after operation,accounting for 32.7%.The results of univariate analysis showed that the skull defect area(≥75 cm3),the depth of the bone window depression(≥1.5 cm),epidural gas,dural calcification and intraoperative dural damage are the risk factors for epidural fluid collection after cranioplasty(P<0.05).Multivariate logistic regression analysis showed that the depth of bone window depression,dural calcification and intraoperative dural damage were independent risk factors for epidural fluid collection after cranioplasty(P<0.05).Conclusion For patients with cranioplasty with a bone window depression depth of≥1.5 cm,dural calcification and intraoperative dural damage,the prevention of complications of epidural fluid collection should be throughout the entire perioperative period.