颅脑外伤去骨瓣减压术后咀嚼功能损害危险因素分析

目的：总结因颅脑外伤行去骨瓣减压术患者的临床资料,探讨术后发生咀嚼功能损害的危险因素。方法：回顾性分析颅脑外伤行去骨瓣减压术患者的临床资料,将患者性别、年龄、入院时GCS评分、颅骨缺损直径、术前意识障碍时间、术后昏迷持续时间以及手术方式等列为影响因素,评估患者术后1个月时的咀嚼功能。通过卡方检验筛选术后发生咀嚼功能损害的危险因素,经多因素Logistic回归分析确定独立危险因素。结果：患者1月时发生咀嚼功能损害96例（占46.60%）。非条件Logistic回归多因素分析显示,年龄为术后1月时发生咀嚼肌乏力的独立危险因素,颅骨缺损直径和颞肌帖覆为术后1月时发生咀嚼肌疼痛的独立危险因素。结论：对于颅脑外伤行去骨瓣减压术患者,年龄≥40岁应注意加强咀嚼功能锻炼,减少手术创伤是避免咀嚼肌疼痛的重要因素。

Risk factors of masticatory dysfunction for patients with traumatic brain injury undergoing decompressive craniotomy

Objective： To summarize the clinical parameters of patients with traumatic brain injury undergoing decompressive craniotomy and evaluate risk factors of postoperative injury of masticatory function. Methods： The clinical data of patients with traumatic brain injury undergoing decompressive craniotomy in our institution were analyzed retrospectively, of which Gender, age, GCS score on admission, diameter of defect, preoperative and postoperative duration of consciousness disorders, and surgical approach were analyzed as influencing factors. Masticatory function at one month after decompressive craniotomy was evaluated. The chi-square test was employed to select risk factors for masticatory dysfunction. Non-condition logistic regression analysis was employed to define the independent risk factors. Results： There were 96 cases （46.60%） with masticatory dysfunction at one month postoperative. The mon-condition logistic regression analysis showed that age was independent risk factor of masticatory muscle fatigue, diameter of defect and temporalis muscle patching were independent risk factors of masticatory muscle pain. Conclusion： Attention should be paid to patients with age ≥40 to enhance masticatory functional exercise postoperatively. Reduction of surgical trauma is essential to avoid muscle pain.