脑膜中动脉扩张对慢性硬膜下血肿发病及预后影响的研究

Effects of middle meningeal artery dilatation on pathogenesis and prognosis of chronic subdural hematoma

目的探讨脑膜中动脉(MMA)扩张对慢性硬膜下血肿(CSDH)发病及预后的影响,为MMA栓塞治疗CSDH提供理论依据。方法回顾性分析2018年1月—2022年6月间在徐州医科大学江阴临床学院接受颅骨钻孔引流手术治疗的48例单侧CSDH患者的临床资料,包括MMA的磁共振血管成像、术后1周及术后1个月的血肿吸收量。对比分析患侧MMA直径是否明显扩张和不同患者的术后血肿吸收情况。结果48例CSDH患者患侧48支MMA平均直径明显大于健侧[分别为(1.738±0.224)mm和(1.361±0.184)mm,t=9.021,P<0.001],MMA扩张组术后1周血肿吸收量与MMA非扩张组无显著性差异(Z=-0.69,P=0.945),MMA扩张组术后1个月血肿吸收量与MMA非扩张组有显著性差异(Z=-2.283,P=0.022)。MMA扩张组的血肿吸收率较MMA非扩张组的血肿吸收率低。结论MMA作为CSDH外膜新生血管的主要供血动脉,MMA扩张在CSDH血肿发生和进展中起到关键作用,并不利于CSDH患者的预后,上述特征性表现为MMA栓塞治疗CSDH提供了理论依据。

Objective To investigate the effect of middle meningeal artery(MMA)dilation on the pathogenesis and prognosis of chronic subdural hematoma(CSDH),and to provide a theoretical basis for MMA embolization in the treatment of CSDH.Methods The clinical data of 48 patients with unilateral CSDH who underwent burr hole and drainage surgery in Affiliated Jiangyin Clinical College of Xuzhou Medical University from January 2018 to June 2022 were analyzed retrospectively,including magnetic resonance angiography of MMA,hematoma absorption at 1 week and 1 month after surgery.The diameter of MMA on the affected side was significantly expanded and the postoperative hematoma absorption of different patients was compared and analyzed.Results The mean diameter of MMA in 48 CSDH patients was significantly larger than that in healthy side[(1.738±0.224)mm vs(1.361±0.184)mm,t=9.021,P<0.001],there was no significant difference in hematoma absorption between the MMA dilatation group and the MMA non-dilatation group at 1 week after operation(Z=-0.69,P=0.945),and there was significant difference in hematoma absorption between the MMA dilatation group and the MMA non-dilatation group at 1 month after operation(Z=-2.283,P=0.022).The rate of hematoma resorption was lower in the MMA dilated group than in the MMA non-dilated group.Conclusions MMA is the main blood supply artery of CSDH advection neovascularization.MMA dilatation plays a key role in the occurrence and progression of CSDH hematoma,which is not conducive to the prognosis of CSDH patients.