颅脑外伤去骨瓣减压术后继发硬膜下积液的危险因素分析

目的分析颅脑外伤去骨瓣减压术后继发性硬膜下积液的危险因素。方法回顾性分析我院2014年1月至2016年6月间的138例颅脑外伤去骨瓣减压术患者的临床资料和影像学资料。根据术后是否发生硬膜下积液分为积液组和非积液组,通过单因素t检验、卡方检验和多因素Logistic回归分析总结颅脑外伤去骨瓣减压术后发生硬膜下积液的影响因素。结果 138例患者中,85例患者发生硬膜下积液,发生率为61.6%。单因素分析结果显示两组患者在性别、年龄、术前GCS评分、环池受压、术前是否合并脑疝、硬膜外血肿、脑内血肿、脑室内出血、蛛网膜下腔出血、骨瓣的前后径大小、骨瓣的最高径大小、去骨瓣减压的侧别均无统计学意义(p0.05)。去骨瓣减压术后硬膜下积液和中线移位大于5 mm、皮层切开、硬膜下血肿、骨瓣边缘距中线距离小于2 mm有明显关联。多因素分析结果显示只有中线移位大于5 mm和皮层切开是危险因素。结论颅脑外伤去骨瓣减压术后继发性硬膜下积液和中线移位大于5mm、皮层切开有明显关联,应引起重视。

Analysis of risk factors for subdural hygroma after decompressive craniectomy for traumatic brain injury

Objective To investigate the risk factors for subdural hygroma (SDG) after decompressive craniectomy (DC) for traumatic brain injury.Methods A retrospective analysis was performed on the clinical data and imaging data of 138 patients who underwent DC for traumatic brain injury in Department of Neurosurgery in our hospital from January 2014 to June 2016.According to the presence or absence of SDG after DC,the patients were divided into SDG group and non-SDG group.The univariate t test,chi-square test,and multivariate logistic regression analysis were used to identify the risk factors for SDG after DC.Results Of the 138 patients,85 (61.6％) had SDG.The univariate analysis showed that there were no significant differences in sex,age,preoperative Glasgow Coma Scale score,compression of the cisterna ambiens,incidence of cerebral hernia before surgery,epidural hematoma,intracerebral hematoma,intraventricular hemorrhage,subarachnoid hemorrhage,anteroposterior diameter of the bone flap,greatest diameter of the bone flap,and side of DC between the SDG group and the non-SDG group (P ＞ 0.05).SDG after DC was significantly associated with midline shift ＞ 5 mm,cortical opening,subdural hematoma,and distance between the margin and midline of the bone flap ＜ 2 cm (P ＜ 0.05).The multivariate analysis showed that midline shift ＞ 5 mm and cortical opening were independent risk factors for SDG after DC (P ＜ 0.05).Conclusions For patients treated with DC for traumatic brain injury,SDG is significantly associated with midline shift ＞ 5 mm and cortical opening.The potential progression into SDG should be taken seriously.