颅骨修补术后出血性并发症的影响因素研究

Study and Discussion on the Influencing Factors of Hemorrhagic Complications after Cranioplasty

摘要: 目的：探究颅骨修补术术后出血性并发症的影响因素，并对研究结果和可能原因进行探讨。方法：回顾性选取了2016年1月至2019年7月行单侧颅骨修补术患者433例。提取临床资料后，对可能的因素行二元多因素Logistic回归分析，并以独立影响因素为依据进行分组，对分组后的临床资料进行Pearson卡方检验或Fisher精确检验，确定独立影响因素影响的出血性并发症的具体类型。结果：共433例患者纳入本研究，二元多因素Logistic回归分析显示，同期行V-P分流术为术后出血性并发症的独立危险因素(odds ratio 4.913; 95% CI 2.479~9.739; p < 0.001)。以是否伴随V-P分流术进行临床资料分组，分组后资料显示两组性别、年龄、去骨瓣减压术与颅骨修补术的间隔时间、原发病、颅骨修补材料均无统计学差异，伴随V-P分流术的颅骨修补患者术后并发脑内血肿的风险更高(P < 0.001)。结论：同期行V-P分流术为术后出血性并发症的独立危险因素，且同期行V-P分流术可以增加脑内血肿的风险。而患者性别、年龄、去骨瓣减压术与颅骨修补术时间间隔、原发病是否凝血相关、修补材料种类尚不能判断为修补术后出血性并发症的影响因素，早期(<3月)行颅骨修补术并不增加出血性并发症发生的可能性。

Abstract: Objective: To investigate the influencing factors of hemorrhagic complications after cranioplasty and discuss the study results and possible causes. Methods: A total of 433 patients who received unilateral cranioplasty in the Affiliated Hospital of Qingdao University from January 2016 to July 2019 were selected retrospectively. Binary multivariate logistic regression analysis was performed for possible factors after clinical data extraction. And Pearson chi-square test or Fisher’s exact test was performed for the clinical data after grouping based on independent influencing factors to identify which type of hemorrhagic complication is influenced by independent risk factors. Results: Binary multivariate logistic regression analysis on the study included 433 patients showed that simultaneous V-P shunt is an independent risk factor for postoperative hemorrhagic complications (odds ratio 4.913; 95% CI 2.479~9.739; p < 0.001). Post-grouping data based on presence or absence of V-P shunt showed no statistically significant differences in gender, age, interval between decompressive craniectomy and cranioplasty, primary disease, and skull repair materials between the two groups, but there was a higher risk of postoperative hematoma in patients undergoing skull repair with V-P shunt (p < 0.001). Conclusion: Independent risk factors for postoperative hemorrhagic complications are simultaneous V-P shunt which can increase the risk of hematoma. However, patient gender, age, time interval between decompressive craniectomy and cranioplasty, whether the primary disease is coagulation related, and type of prosthetic material cannot be judged as the influencing factors of hemorrhagic complications after repair. Early (<3 months) cranioplasty does not increase the possibility of hemorrhagic complications.