创伤性颅脑损伤患者去骨瓣减压术的骨瓣面积与创伤后正常压力脑积水的关系

摘要

目的 探讨创伤性颅脑损伤患者行去骨瓣减压的骨瓣面积与创伤后正常压力脑积水的关系.方法 回顾性纳入2012年1月至2018年4月于空军军医大学唐都医院神经外科行单侧去骨瓣减压术的34例创伤性颅脑损伤患者,12例术后发生脑积水(脑积水组),22例未发生脑积水(对照组).采用单因素分析和多因素logistic回归分析方法分析患者的性别、年龄、术前格拉斯哥昏迷评分(GCS)、是否为开放性损伤、术前CT中线的偏移距离、手术时长、术后颅内压、颅内感染情况以及行去骨瓣减压的骨瓣面积与术后脑积水发生的关系,探讨创伤后正常压力脑积水发生的影响因素.结果 单因素分析结果显示,年龄(P =0.016)、术前GCS(P =0.018)、骨瓣面积(P＜0.001)均与创伤后正常压力脑积水的发生有关;而性别、是否为开放性损伤、术前CT中线偏移距离、手术时长、术后颅内压及颅内感染情况在两组间的差异无统计学意义(均P ＞0.05).多因素logistic回归分析结果显示,骨瓣面积(OR=1.138,95％ CI:1.005～1.288,P =0.042)是创伤后正常压力脑积水发生的危险因素.结论 创伤后正常压力脑积水的发生与创伤性颅脑损伤患者行去骨瓣减压术的骨瓣面积有关.%Objective To analyze the effect of craniotomy area on the development of normal pressure hydrocephalus after decompressive craniotomy.Methods The clinical data of 34 patients with traumatic brain injury who underwent unilateral craniotomy from January 2012 to April 2018 at Department of Neurosurgery,Tangdu Hospital,Airforce Military Medical University were retrospectively analyzed.The effects of multiple factors on hydrocephalus,including the gender,age,Glasgow coma scale before craniotomy,open injury,extent of midline shift on CT before craniectomy,duration of operation,intracranial pressure after craniotomy,cerebrospinal fluid infection and craniotomy area were analyzed.Results Univariate analysis showed that the age (P =0.016),preoperative Glasgow coma scale (P =0.018),craniotomy area (P ＜0.001) were all associated with hydrocephalus.However,the gender,open injury,extent of midline shift on CT before craniectomy,duration of operation,intracranial pressure after craniotomy,cerebrospinal fluid infection were not influencing factors of postoperative hydrocephalus(all P ＞ 0.05).It was also suggested by multiple logistic regression that craniotomy area (OR =1.138,95％ CI:1.005-1.288,P =0.042) was an independent risk factor for hydrocephalus.Conclusion After decompressive craniotomy,the skull defect area may increase the risk of hydrocephalus.