脑膜中动脉栓塞与传统方法治疗慢性硬膜下血肿疗效的倾向性评分匹配对比研究

Comparison of the efficacy of middle meningeal artery embolization and conventional therapy for chronic subdural hematomas:a propensity score matching study

目的:比较脑膜中动脉栓塞(MMAE)和传统治疗方法对慢性硬膜下血肿(CSDH)的治疗效果。方法:回顾性分析2019年5月至2021年5月间经MMAE治疗38例(48侧CSDH)患者的临床资料,并与2016年1月至2021年5月间经传统方法(保守及外科钻孔引流术)治疗126例(162侧CSDH)患者的资料进行对比。应用倾向性评分匹配法对MMAE和传统方法治疗的患者进行匹配,共25例(31侧CSDH)匹配成功。采用t检验、Mann-Whitney U检验、χ2检验或Fisher确切概率法,比较2组间CSDH复发率、挽救性二次手术率、影像学随访结果、临床症状改善及并发症等。结果:MMAE组挽救性二次手术率[0(0/31)与19.4%(6/31),P=0.024]明显低于传统治疗组,MMAE组6个月随访血肿完全吸收率明显高于传统治疗组[96.8%(30/31)与74.2%(23/31),P=0.026],差异均有统计学意义。MMAE组较传统治疗组具有更低的CSDH复发率趋势[3.2%(1/31)与22.6%(7/31),P=0.053]。两组患者3个月随访血肿完全吸收率分别为61.3%(19/31)和45.2%(14/31),临床症状改善率分别为92.0%(23/25)和88.0%(22/25),良好预后(mRS评分≤2分)率分别为92.0%(23/25)和84.0%(21/25),并发症的发生率分别为0(0/25)和4.0%(1/25),差异均无统计学意义(均P>0.05)。结论:MMAE可能是治疗CSDH安全有效的方法。与传统治疗方法相比MMAE与更低的CSDH复发趋势,更低的挽救性二次手术率及更好的影像学随访结果相关。

Objective To compare the effect of middle meningeal artery embolization(MMAE)versus conventional therapy for chronic subdural hematoma(CSDH).Methods Retrospective analysis of 38 patients with 48 CSDHs treated with MMAE from May 2019 to May 2021 was performed.Comparisons were made with a conventional treatment for 126 patients with 126 CSDHs from January 2016 to May 2021.The MMAE and conventional treatment patients were matched by the propensity score matching method,and a total of 25 pairs of patients(31 pairs of CSDHs)were successfully matched.The CSDH recurrence,rescue treatment,radiographic follow-up outcome,clinical improvement and complication between the two groups were compared by t test,χ2 test or Fisher exact probability methods.Results The rescue treatment rate in MMAE group was significantly lower than that in conventional treatment group[0(0/31)vs 19.4%(6/31),P=0.024]and the complete resolution rate at 6 months follow-up in MMAE group was significantly higher than that in conventional treatment group[96.8(30/31)vs 74.2%(23/31),P=0.026].In terms of CSDH recurrence,there was a trend of lower recurrence in the MMAE group[3.2%(1/31)vs 22.6%(7/31),P=0.053].The complete resolution rate at 3 months follow-up was 61.3%(19/31)in MMAE group and 45.2%(14/31)in conventional treatment,clinical improvement rate was 92.0%(23/25)in MMAE group and 88.0%(22/23)in conventional treatment,good outcome rate(mRS≤2)was 92.0%(23/25)in MMAE group and 84.0%(21/25)in conventional treatment,complication rate was 0(0/25)in MMAE group and 4.0%(1/25)in conventional treatment,and there were no significant differences in all above-mentioned parameters(P>0.05).Conclusions The MMAE may be considered as a safe and effective treatment for CSDH,and MMAE for CSDH is associated with lower trend of recurrence,lower rescue treatment rate and better radiographic follow-up outcome than conventional therapy.