数字化成形钛网颅骨修补术后术区出血危险因素分析  

Analysis of risk factors of postoperative hemorrhage after cranioplasty

作　　者：王宣之 徐善水 方兴根 李真保 戴易 江晓春 WANG Xuanzhi;XU Shanshui;FANG Xinggen;LI Zhenbao;DAI Yi;JIANG Xiaochun(Department of Neurosurgery,Yijishan Hospital,Wannan Medical College,Wuhu 241001,China)

机构地区：[1]皖南医学院第一附属医院(皖南医学院弋矶山医院)神经外科,芜湖241000

出　　处：《中国神经精神疾病杂志》2020年第4期221-225,共5页Chinese Journal of Nervous and Mental Diseases

基　　金：皖南医学院重点科研项目(编号:WK2019ZF02)。

摘　　要：目的探讨颅骨修补术后术区出血的危险因素,为颅骨修补术后术区出血的防治提供理论依据。方法回顾性分析155例颅骨修补患者临床资料,根据术后术区有无出血将患者分为出血组和未出血组,采用多因素Logistic回归分析筛选出颅骨修补术后术区出血的独立危险因素,通过绘制受试者工作特征曲线(receiver operating characteristic,ROC),评价危险因素对术后出血的预测价值。结果155例颅骨修补患者中,术后出现术区血肿32例,占20.65%。两组患者在钛网位置(Х^2=14.180)、皮瓣塌陷(Х^2=5.520)和颅骨缺损面积(t=2.921)上存在差异(均P<0.05)。二分类多因素logistic回归分析提示钛网位置(OR=0.174,95%CI:0.064~0.476,P=0.001)、皮瓣塌陷(OR=3.652,95%CI:1.358~9.819,P=0.010)和颅骨缺损面积(OR=1.047,95%CI:1.006~1.089,P=0.023)是颅骨修补术后术区出血的独立危险因素。钛网位置、皮瓣塌陷和颅骨缺损面积单独预测术后出血的ROC曲线下面积分别为0.683(95%CI:0.585~0.781)、0.614(95%CI:0.510~0.719)和0.678(95%CI:0.584~0.773),三者联合预测的ROC曲线下面积为0.792(95%CI:0.714~0.870)。结论钛网置于颞肌外、皮瓣塌陷和大面积颅骨缺损是颅骨修补术后术区出血的独立危险因素,均能单独预测术后出血,三者联合预测修补术后术区出血有较高的准确性。Objective To explore the related risk factors of postoperative hemorrhage after cranioplasty,and to provide theoretical basis for the prevention and treatment of postoperative hemorrhage.Methods The clinical data of 155 patients with cranioplasty were retrospectively analyzed.The patients were divided into hemorrhage group and non hemorrhage group according to the occurrence of postoperative hemorrhage.Univariate analysis and multivariate Logistic regression analysis were used to examine the risk factors of postoperative hemorrhage after cranioplasty and the receiver operating characteristic curve(ROC)was conducted to evaluate the predictive value of various risk factors for postoperative hemorrhage.Results Among 155 cases of cranioplasty,32 cases had hematoma and the incidence was 20.65%.Univariate analysis showed that there were significant differences in titanium mesh location,flap collapse and skull defect area between the two groups(P<0.05).Multivariate Logistic regression analysis showed that titanium mesh location,flap collapse and skull defect area were independent risk factors of postoperative hemorrhage.For predicting postoperative hemorrhage,the area under ROC curve of titanium mesh location,flap collapse,skull defect area,and the combination of the three were 0.683,0.614,0.678 and 0.792,respectively.Conclusion The titanium mesh location,flap collapse and skull defect area are the independent risk factors of postoperative hemorrhage.The combined prediction of these three factors achieve a high accuracy for postoperative hemorrhage following cranioplasty.

关 键 词：颅骨修补术 术后出血 ROC曲线 

分 类 号：R651[医药卫生—外科学]