文章摘要
曾浩,陈玉霞,成泉江.颅脑损伤去骨瓣减压病人行颅骨修补术后继发硬膜外积液的原因及治疗策略[J].安徽医药,2022,26(2):326-330.
颅脑损伤去骨瓣减压病人行颅骨修补术后继发硬膜外积液的原因及治疗策略
Causes and treatment strategies of secondary epidural effusion after cranioplasty in patients with traumatic brain injury after decompressive craniectomy
  
DOI:10.3969/j.issn.1009-6469.2022.02.028
中文关键词: 硬膜下积液  再手术  颅骨修补术  颅脑损伤  去骨瓣减压
英文关键词: Subdural effusion  Reoperation  Cranioplasty  Craniocerebral injury  Decompressive craniectomy
基金项目:
作者单位
曾浩 深圳市龙华区中心医院神经外科广东深圳 518110 
陈玉霞 深圳市龙华区中心医院神经外科广东深圳 518110 
成泉江 深圳市龙华区中心医院神经外科广东深圳 518110 
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中文摘要:
      目的总结颅脑损伤去骨瓣减压病人行颅骨修补术后继发硬膜外积液的原因以及相应的治疗策略。方法回顾性分析深圳市龙华区中心医院 2017年 1月至 2019年 8月收治的 130例行颅骨修补术的颅脑损伤去骨瓣减压病人临床资料,依据是否继发硬膜外积液分为未发组 100例及继发组 30例,比较两组基本资料,进行多因素 logistic回归分析,总结诱发颅骨修补术后继发硬膜外积液的原因及治疗策略。结果单因素比较提示,未发组与继发组中线移位距离[>5 mm为 32.00%比 60.00%,≤ 5 mm为 68.00%比 40.00%]、骨瓣边缘距中线距离[>2 cm为 19.00%比 40.00%,≤2 cm为 81.00%比 60.00%]、是否存在硬膜下血肿[有: 34.00%比 80.00%,无: 66.00%比 20.00%]、皮层切开与否[是: 30.00%比 50.00%,否: 70.00%比 50.00%]、引流管拔除时间[(3.25±0.20)d比( 1.85±0.15)d]差异有统计学意义( P<0.05),其余指标差异无统计学意义( P>0.05);多因素 logistic回归分析结果提示中线移位距离、皮层切开、引流管拔除时间为颅脑损伤去骨瓣减压病人行颅骨修补术后继发硬膜外积液的独立风险因素( P<0.05); 30例继发硬膜外积液病人经保守治疗、穿刺引流治疗后均临床治愈。结论中线移位距离、皮层切开、引流管拔除时间为颅脑损伤去骨瓣减压病人行颅骨修补术后继发硬膜外积液的重要诱因,结合病人实际予以保守治疗、穿刺引流能够取得理想的临床疗效。
英文摘要:
      Objective To summarize the causes and the corresponding treatment strategies of secondary epidural effusion after cra.nioplasty in patients with traumatic brain injury after decompressive craniectomy.Methods Clinical data of 130 case of patients withtraumatic brain injury after decompressive craniectomy and who treated with cranioplasty in Shenzhen Longhua District Central Hospi.tal from January 2017 to August 2019 were retrospective analyzed, and the patients were assigned into the non hair group of 100 casesand the secondary group of 30 cases according to whether or not secondary epidural effusion occurred. The factors with statistical differ.ences were analyzed by the multivariate logistic regression analysis, and the causes and treatment strategies of secondary epidural effu.sion after cranioplasty were summarized.Results The univariate comparison indicated that there was significant differences in the dis. tance between the midline shift [>5 mm: 32.00% vs. 60.00%; ≤5 mm: 68.00% vs. 40.00%], the distance between the edge of the bone flap and the midline [>2 cm:19.00% vs. 40.00%; ≤2 cm: 81.00% vs. 60.00%], the existence of subdural hematoma [yes: 34.00% vs. 80.00%; no: 66.00% vs. 20.00%], the incision of the cortex [yes: 30.00% vs. 50.00%; no: 70.00% vs. 50.00%] and the removal time of the drainage tube [(3.25±0.20) d vs. (1.85±0.15) d] of the non hair group and the secondary group (P<0.05), and there was no significant difference in other indexes (P>0.05). Multivariate logistic regression analysis showed that the distance of midline shift, the time of corti.cal incision and drainage tube extraction were the independent risk factors of secondary extradural effusion after cranioplasty for pa.tients with craniocerebral injury (P<0.05); 30 cases of patients with secondary epidural effusion were cured by conservative treatment and puncture and drainage.Conclusions The distance of midline shift, the time of cortical incision and drainage tube extraction areimportant inducements for secondary epidural effusion after cranioplasty in patients with craniocerebral injury undergoing decompres.sion of craniotomy flaps.The conservative treatment and puncture and drainage combined with the actual situation of patients canachieve ideal clinical effect.
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