颅脑损伤去骨瓣减压行颅骨修补术后继发硬膜外积液原因及治疗策略

Causes and treatment strategies of secondary epidural effusion after cranioplasty following decompressive craniectomy in patients with traumatic brain injury

目的总结颅脑损伤去骨瓣减压患者行颅骨修补术后继发硬膜外积液的原因以及相应的治疗策略。方法回顾性分析海南省第二人民医院神经外科2010年1月至2019年12月收治的130例行颅骨修补术的颅脑损伤去骨瓣减压患者临床资料,依据是否继发硬膜外积液分为未发组及继发组,对两组患者的基本资料进行比较后将具有统计学差异的因素进行多因素Logistic回归分析,总结诱发颅骨修补术后继发硬膜外积液的原因并总结具体的治疗策略。结果130例颅脑损伤去骨瓣减压患者中有50例继发硬膜外积液,发生率为38.50%;单因素分析结果显示,未发组及继发组患者的中线移位距离>5 mm、骨瓣边缘距中线距离>2 mm、是否存在硬膜下血肿、皮层切开与否差异均有统计学意义(P<0.05);多因素Logistic回归分析结果显示,中线移位>5 mm(OR:5.587;95%CI:2.651~7.774)、皮层切开(OR:5.567;95%CI:2.538~7.651)为颅脑损伤去骨瓣减压患者行颅骨修补术后继发硬膜外积液的独立风险因素(P<0.05);50例继发硬膜外积液患者经保守治疗、穿刺引流治疗后均临床治愈。结论中线移位>5 mm、皮层切开为颅脑损伤去骨瓣减压患者行颅骨修补术后继发硬膜外积液的重要诱因,结合患者实际予以保守治疗、穿刺引流能够取得理想的临床疗效。

Objective To summarize the causes and treatment strategies of secondary epidural effusion after cranioplasty following decompressive craniectomy in patients with traumatic brain injury.Methods A retrospective analysis was conducted on the clinical data of 130 traumatic brain injury patients who underwent cranioplasty following decompressive craniectomy in the Second People’s Hospital of Hainan Province from January 2012 to December 2019.The patients were divided into a non-recurrent group and a secondary group according to whether there is secondary epidural effusion.After comparing the basic data of the two groups,factors with statistical differences were analyzed by multivariate logistic regression,and the reasons for inducing secondary epidural effusion after cranioplasty were summarized,as well as the specific treatment strategies.Results Among the 130 traumatic brain injury patients who underwent cranioplasty following decompressive craniectomy,50 patients had secondary epidural effusion,the incidence was38.5%.The univariate analysis showed that there were statistically significant differences in the midline shift of>5 mm,the gap between bone flap edge and midline of>2 cm,presence or absence of subdural hemorrhage and cortical incision between the non-onset group and the secondary group(P<0.05).The multivariate logistic regression analysis showed that the midline shift of>5 mm(OR:5.587;95%CI:2.651-7.774)and presence of cortical incision(OR:5.567;95%CI:2.538-7.651)were independent risk factors for secondary epidural effusion after cranioplasty following decompressive craniectomy in patients with traumatic brain injury(P<0.05).50 patients with secondary epidural effusion were cured clinically after conservative treatment as well as puncture and drainage treatment.Conclusion Midline shift of>5 mm and cortical incision are important inducements for secondary epidural effusion after cranioplasty following decompressive craniectomy in patients with traumatic brain injury.Conservative treatment as well as puncture and drainage treatment can achieve ideal clinical effect in combination with the actual situation of patients.