外伤性颅骨缺损修补术后癫痫发作相关因素分析

Analysis of correlative factors of epileptic seizure after traumatic skull defect repair

目的探讨外伤性颅骨缺损修补术后癫痫发作的相关高危因素,明确癫痫高危人群。方法回顾性分析2010年1月至2020年12月在山东大学齐鲁医院德州医院进行颅骨修补手术后的112例外伤性颅骨缺损患者的临床资料,根据是否出现癫痫发作将患者分为癫痫发作组(33例)和无癫痫发作组(79例),采用单因素分析两组人口统计学数据、去骨瓣减压术病因、骨窗位置大小、是否使用人工硬脑膜、格拉斯哥评分、两次手术间隔时间、修补材料、手术时间。多因素logistic回归分析法分析外伤性颅骨缺损修补术后癫痫发作的相关因素。结果颅骨修补手术后癫痫发作率29.5%,癫痫类型以全面性强直阵挛发作为主。单因素分析结果提示,癫痫发作组与无癫痫发作组的去骨瓣减压手术的病因及修补材料比较,差异有统计学意义(P<0.05);多因素logistic回归分析结果提示,去骨瓣减压手术原因脑挫伤(β=-2.558,OR=0.077,95%CI=0.013~0.450)、修补材料自体骨(β=1.431,OR=4.182,95%CI=1.317~13.285)是外伤性颅骨缺损修补术后癫痫发作的影响因素,差异有统计学意义(P<0.05)。结论颅骨修补手术后癫痫发生率与去骨瓣减压术病因和修补材料相关,即因脑挫伤行减压术并自体骨修补者为高危人群。

Objective To investigate the risk factors of epileptic seizure after traumatic skull defect repai,and identify the high-risk group of epileptic seizure.Methods The clinical data of 112 patients with traumatic skull defect who underwent skull repair surgery in Qilu Hospital of Shandong University Dezhou Hospital from January 2010 to December 2020 were retrospectively analyzed.Patients were divided into epileptic group(33 cases)and non-epileptic group(79 cases)according to whether they had epilepsy or not.Univariate analysis was used to analyze the demographic data of the two groups,the etiology of decompressive craniectomy,the location of bone window,whether artificial dural membrane was used,Glasgow score,interval between operations,repair materials,and operation time.Logistic regression analysis was used to analyze the related factors of epileptic seizure after traumatic skull defect repair.Results The rate of epileptic seizures after cranioplasty was 29.5%,and the main type of epilepsy was generalized tonic-clonic seizures.The results of univariate analysis showed that there were statistically significant differences in the etiology and repair materials of decompressive craniectomy between the epileptic group and the non-epileptic group(P<0.05).Logistic regression analysis indicated that cerebral contusion(β=-2.558,OR=0.077,95%CI=0.013-0.450),and autologous bone(β=1.431,OR=4.182,95%CI=1.317-13.285)was the influential factor of epileptic seizure after traumatic skull defect repair,and the differences were statistically significant(P<0.05).Conclusion The incidence of epilepsy after cranioplasty is related to the etiology and repair materials of decompressive cranioplasty,the patients who underwent decompressive cranioplasty and autogenous bone repair due to brain contusion are high-risk groups.