不同颅骨材料颅骨修补术后并发症分析

摘要

目的 探讨颅骨修补术的术后并发症与修补材料、修补时机、手术方法等的相关性.方法 回顾性分析首都医科大学附属北京天坛医院1997年1月～2014年12月接受颅骨成形术的351例患者的临床资料,其中男性275例,女性76例;年龄2～71岁,平均37岁.修补材料包括钛网(281例)、自体骨(42例)、硅胶(28例).统计分析颅骨修补术后并发症与所用修补材料及其他相关因素的相关性.结果 本组病例总体并发症发生率为8％(29/351),其中感染 15例,头皮下积液 4例,颅内血肿2例,修补材料松动5例,癫3例.相关单因素统计学分析,总体并发症的发生率相关因素包括术中放置头皮下引流管(P=0.02)、修补材料(P=0.002).是否放置引流管因素的多因素Logistic回归分析显示回归系数为-1.273,表明与是否放置引流管这个因素负相关.硅胶组术后并发症发生率(25％)显著高于钛网组(6％)及自体骨组(9％).患者的年龄、性别、修补时机、缺损原因、修补侧别等对于并发症无显著意义.结论 选用合适的修补材料可能会降低术后并发症的发生,术中放置头皮下引流管可降低总体并发症的发生.%Objective To investigate the correlation between the postoperative complications of cranioplasty and repair materials,repair time and surgical methods.Methods The clinical data of 351 patients,including 275 males and 76 females with an average age of 37(2-71) years,who underwent cranioplasty in Beijing Tiantan Hospital of Capital Medical University from Jan.1997 to Dec.2014,were retrospectively analyzed.The repair materials included titanium mesh (n=281),autologous bone (n=42) and silica gel (n=28).Statistical analysis of the correlation between the complications of cranioplasty and repair materials and other related factors was carried out.Results The overall complication rate of this group was 8％ (29/351),including infection in 15 cases,scalp effusion in 4 cases,intracranial hematoma in 2 cases,repair material loosening in 5 cases,and epilepsy in 3 cases.Statistical analysis of related factors showed that the incidence of overall complications was related to intraoperative placement of scalp drainage tube (P=0.02) and repair materials (P=0.002).Multi-factor Logistic regression analysis showed that the regression coefficient was-1.273,indicating that the drainage tube was negatively correlative.The incidence of postoperative complications was significantly higher in silica gel group (25％) than in titanium mesh group (6％) and autologous bone group (9％).There was no significant difference in the age,gender,timing of repair,cause of defect,or side of repair.Conclusion The use of appropriate repair materials may reduce the incidence of postoperative complications,and the placement of scalp drainage tube can reduce the incidence of complications.