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湖南中医药大学第一附属医院神经外科,湖南 长沙 410000
张茜,E-mail:124165637@qq.com
收稿:2025-08-06,
纸质出版:2026-05-25
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邓茜,张茜,张占伟等.颅骨修补术后继发硬脑膜外积液的影响因素分析[J].局解手术学杂志,2026,35(05):449-452.
DENG Qian,ZHANG Qian,ZHANG Zhan-wei,et al.Analysis on influencing factors of secondary epidural fluid collection after cranioplasty[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2026,35(05):449-452.
邓茜,张茜,张占伟等.颅骨修补术后继发硬脑膜外积液的影响因素分析[J].局解手术学杂志,2026,35(05):449-452. DOI: 10.11659/jjssx.08E025029.
DENG Qian,ZHANG Qian,ZHANG Zhan-wei,et al.Analysis on influencing factors of secondary epidural fluid collection after cranioplasty[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2026,35(05):449-452. DOI: 10.11659/jjssx.08E025029.
目的
2
探讨颅骨修补术后继发硬脑膜外积液(EFC)的影响因素。
方法
2
回顾性分析2022年6月至2024年6月我院收治的96例使用钛网行颅骨修补术后继发EFC患者的临床资料。根据术后6个月是否继发EFC,将患者分成继发EFC组(30例)和未继发EFC组(66例)。采用单因素分析和多因素
Logistic
回归分析颅骨修补术后继发EFC的影响因素。
结果
2
与未继发EFC组相比,继发EFC组患者手术时间延长,术中出血量、缺损面积、骨窗凹陷深度、潜在无效腔体积增加,硬脑膜破损、硬脑膜外钙化占比升高,差异均有统计学意义(
P
0.05)。多因素
Logistic
回归分析显示,手术时间长(
OR
=1.931,95%
CI
:1.204~3.268),术中出血量(
OR
=1.972,95%
CI
:1.089~3.430)、缺损面积(
OR
=1.956,95
%CI
:1.215~3.085)、骨窗凹陷深度(
OR
=2.020,95%
CI:
1.208~4.750)、潜在无效腔体积(
OR
=2.962,95%
CI
:1.161~7.556)增加,合并硬脑膜破损(
OR
=1.976,95%
CI
:1.227~2.852)及硬脑膜外钙化(
OR
=1.910,95%
CI
:1.120~3.005)均是颅骨修补术后继发EFC的独立危险因素(
P
0.05)。
结论
2
颅骨修补术后EFC的形成可能与手术创伤反应及局部解剖结构适配性相关,手术时间、术中出血量、硬脑膜破损在早期EFC发生中起主导作用,而缺损面积、骨窗凹陷深度、潜在无效腔体积对迟发性EFC的影响更为显著。
Objective
2
To explore the influencing factors of secondary epidural fluid collection (EFC) after cranioplasty.
Methods
2
A retrospective analysis was conducted on the clinical data of 96 patients
who developed secondary EFC following cranioplasty with titanium mesh in our hospital from June 2022 to June 2024. Based on whether there was secondary EFC 6 months after surgery,the patients were divided into the secondary EFC group(
n
=30) and the non-secondary EFC group(
n
=66).Univariate analysis and multivariate
Logistic
regression analysis were used to analyze the influencing factors of secondary EFC after cranioplasty.
Results
2
Compared with the non-secondary EFC group,the operation time of patients in the secondary EFC group was prolonged, the intraoperative blood loss, defect area,depth of bone window depression,potential dead space volume were increased,and the proportions of dural defects and epidural calcification were elevated,the differences were statistically significant (
P
0.05). Multivariate
Logistic
regression analysis showed that the longer operation time (
OR
=1.931,95%
CI
:1.204 to 3.268),more intraoperative blood loss (
OR
=1.972,95%
CI
:1.089 to 3.430),large defect area (
OR
=1.956,95%
CI
:1.215 to 3.085),the increased depth of bone window depression (
OR
=2.020,95%
CI
:1.208 to 4.750),the large potential dead space volume (
OR
=2.962, 95%
CI
: 1.161 to 7.556),and presence of dural defects (
OR
=1.976, 95%
CI
:1.227 to 2.852) and epidural calcification (
OR
=1.910,95%
CI
:1.120 to 3.005) were the independent risk factors for secondary EFC after cranioplasty (
P
0.05).
Conclusion
2
The development of EFC following cranioplasty appears to be associated with both surgical trauma response and local anatomical compatibility. The operation time, intraoperative blood loss and dural defects play a leading role in the occurrence of early EFC, while the defect area, the depth of bone window depression and the potential dead space volume have a more significant impact on delayed EFC.
Bernhardt K , McClune W , Rowland MJ , et al . Hypertonic saline versus other intracranial-pressure-lowering agents for patients with acute traumatic brain injury: a systematic review and meta-analysis [J]. Neurocrit Care , 2024 , 40 ( 2 ): 769 - 784 . doi: 10.1007/s12028-023-01771-9 http://dx.doi.org/10.1007/s12028-023-01771-9 .
贾瑶 , 梁新慧 , 吴惟 , 等 . 医疗失效模式与效应分析在颅脑创伤急诊手术护理风险管理中的应用 [J]. 实用临床医药杂志 , 2024 , 28 ( 8 ): 127 - 133 . doi: 10.7619/jcmp.20234257 http://dx.doi.org/10.7619/jcmp.20234257 .
Siponkoski ST , Martínez-Molina N , Kuusela L , et al . Music therapy enhances executive functions and prefrontal structural neuroplasticity after traumatic brain injury: evidence from a randomized controlled trial [J]. J Neurotrauma , 2020 , 37 ( 4 ): 618 - 634 . doi: 10.1089/neu. 2019.6413 http://dx.doi.org/10.1089/neu.2019.6413 .
Beck J , Fung C , Strbian D , et al . Decompressive craniectomy plus best medical treatment versus best medical treatment alone for spontaneous severe deep supratentorial intracerebral haemorrhage: a randomised controlled clinical trial [J]. Lancet , 2024 , 403 ( 10442 ): 2395 - 2404 . doi: 10.1016/S0140-6736(24)00702-5 http://dx.doi.org/10.1016/S0140-6736(24)00702-5 .
申向竹 , 张山 , 韩亚非 , 等 . 联合手术对脑外伤患者的临床效果及术后硬膜下积液的危险因素分析 [J]. 实用临床医药杂志 , 2021 , 25 ( 11 ): 22 - 25 . doi: 10.7619/jcmp.20210484 http://dx.doi.org/10.7619/jcmp.20210484 .
Zhou W , Wang Z , Zhu H , et al . Effects of cranioplasty on contralateral subdural effusion after decompressive craniectomy: a literature review [J]. World Neurosurg , 2022 , 165 : 147 - 153 . doi: 10.1016/j.wneu. 2022.06.117 http://dx.doi.org/10.1016/j.wneu.2022.06.117 .
Lin MJ . Intractable subdural effusion after decompressive craniectomy for traumatic brain injury: a case report [J]. World J Clin Cases , 2025 , 13 ( 17 ): 103350 . doi: 10.12998/wjcc.v13.i17.103350 http://dx.doi.org/10.12998/wjcc.v13.i17.103350 .
Chen L , Li J , Huang S , et al . Perioperative management and prevention of postoperative complications in patients undergoing cranioplasty with polyetheretherketone [J]. J Plast Reconstr Aesthet Surg , 2023 , 84 : 71 - 78 . doi: 10.1016/j.bjps.2023.05.019 http://dx.doi.org/10.1016/j.bjps.2023.05.019 .
张尚明 , 李松远 , 陈宏颉 , 等 . 侧脑室-腹腔分流术后或同期行颅骨修补术继发硬膜外积液的危险因素和疗效分析 [J]. 中华神经外科杂志 , 2020 , 36 ( 11 ): 1165 - 1169 . doi: 10.3760/cma.j.cn112050-20200119-00028 http://dx.doi.org/10.3760/cma.j.cn112050-20200119-00028 .
Anderson B , Harris P , Mozaffari K , et al . Comparison of perioperative and long-term outcomes following peek and autologous cranioplasty: a single institution experience and review of the literature [J]. World Neurosurg , 2023 , 180 : e127 - e134 . doi: 10.1016/j.wneu.2023. 09.005 http://dx.doi.org/10.1016/j.wneu.2023.09.005 .
Gerstl JVE , Rendon LF , Burke SM , et al . Complications and cosmetic outcomes of materials used in cranioplasty following decompressive craniectomy-a systematic review,pairwise meta-analysis,and network meta-analysis [J]. Acta Neurochir (Wien) , 2022 , 164 ( 12 ): 3075 - 3090 . doi: 10.1007/s00701-022-05251-5 http://dx.doi.org/10.1007/s00701-022-05251-5 .
Schievink WI , Maya MM , Tay ASS , et al . Lateral spinal csf leaks in patients with spontaneous intracranial hypotension:radiologic-anatomic study of different variants [J]. AJNR Am J Neuroradiol , 2024 , 45 ( 7 ): 951 - 956 . doi: 10.3174/ajnr.A8261 http://dx.doi.org/10.3174/ajnr.A8261 .
Mraček J , Mork J , Dostal J , et al . Complications following decompressive craniectomy [J]. J Neurol Surg A Cent Eur Neurosurg , 2021 , 82 ( 5 ): 437 - 445 . doi: 10.1055/s-0040-1721001 http://dx.doi.org/10.1055/s-0040-1721001 .
Matsuhashi A , Takai K , Taniguchi M . Microsurgical anatomy and treatment of dural defects in spontaneous spinal cerebrospinal fluid leaks [J]. J Neurosurg Spine , 2020 , 34 ( 3 ): 522 - 530 . doi: 10.3171/2020.6.SPINE20487 http://dx.doi.org/10.3171/2020.6.SPINE20487 .
Yao S , Zhang Q , Mai Y , et al . Outcome and risk factors of complications after cranioplasty with polyetheretherketone and titanium mesh: a single-center retrospective study [J]. Front Neurol , 2022 , 13 : 926436 . doi: 10.3389/fneur.2022.926436 http://dx.doi.org/10.3389/fneur.2022.926436 .
曾浩 . 颅脑损伤去骨瓣减压患者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 . doi: 10.3969/j.issn.1009-6469.2022.02.028 http://dx.doi.org/10.3969/j.issn.1009-6469.2022.02.028 .
Häni L , Fung C , El Rahal A , et al . Distinct pattern of membrane formation with spinal cerebrospinal fluid leaks in spontaneous intracranial hypotension [J]. Oper Neurosurg (Hagerstown) , 2024 , 26 ( 1 ): 71 - 77 . doi: 10.1227/ons.0000000000000914 http://dx.doi.org/10.1227/ons.0000000000000914 .
杨昌立 , 王铁峰 , 陈茗伟 , 等 . 颅脑损伤去骨瓣减压行颅骨修补术后继发硬膜外积液原因及治疗策略 [J]. 海南医学 , 2021 , 32 ( 19 ): 2543 - 2545 . doi: 10.3969/j.issn.1009-6469.2022.02.028 http://dx.doi.org/10.3969/j.issn.1009-6469.2022.02.028 .
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