慢性硬膜下血肿复发的影像学因素分析

doi:10.3877/cma.j.issn.2095-9141.2019.06.006

中华神经创伤外科电子杂志 ›› 2019, Vol. 05 ›› Issue (06) : 345 -348. doi: 10.3877/cma.j.issn.2095-9141.2019.06.006

所属专题：文献；

临床研究

慢性硬膜下血肿复发的影像学因素分析

张毅¹, 严红燕¹, 彭强², 戴勇¹, 王蕾²^,^†(

)

^1. 226001　南通，南通大学第二附属医院神经外科
^2. 226001　南通，南通大学第二附属医院急诊中心

收稿日期:2019-06-10 出版日期:2019-12-15
通信作者: 王蕾
基金资助:
江苏省科技厅自然科学基金(BK20161290); 南通市科技计划项目(MS12015109); 南通市卫计委科研项目(WKZL2018024)

Analysis on imaging related factors of recurrence of chronic subdural hematoma

Yi Zhang¹, Hongyan Yan¹, Qiang Peng², Yong Dai¹, Lei Wang²^,^†()

^1. Department of Neurosurgery, the Second Hospital Affiliated to Nantong University, Nantong 226001, China
^2. Department of Emergency Center, the Second Hospital Affiliated to Nantong University, Nantong 226001, China

Received:2019-06-10 Published:2019-12-15
Corresponding author: Lei Wang
About author:
Corresponding author: Wang Lei, Email: wangleilei2339@163.com

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目的

通过影像学检查评估慢性硬膜下血肿（CSDH）复发的危险因素。

方法

收集2014年1月至2018年12月在南通大学第二附属医院神经外科接受CSDH手术治疗的113例患者的临床资料。所有患者均接受钻孔外引流手术治疗，术后随访时间超过3个月，比较复发组与未复发组患者的临床资料，采用多因素Logistic回归分析CSDH患者复发的危险因素。

结果

113例患者中，术后复发患者10例，未复发患者103例，术后复发率8.8%。复发组患者与非复发组患者在性别、年龄、术前血肿厚度、中线偏移比较差异均无统计学意义（P>0.05），复发组与未复发组患者的血肿类型、血肿侧别比较，差异均具有统计学意义（P<0.05）。将单因素分析中有统计学意义的变量纳入Logistic回归分析，结果显示术前分隔分层和双侧血肿是CSDH复发的独立危险因素。

结论

影像学术前血肿分隔分层型和双侧血肿是CSDH复发的危险因素。

关键词: 慢性硬膜下血肿, 复发, 影像学因素

Objective

To evaluate and predict the related factors of chronic subdural hematoma (CSDH) recurrence by imaging examination.

Methods

Clinical data of 113 patients who underwent surgical treatment of CSDH in neurosurgery at the Second Hospital Affiliated to Nantong University from January 2014 to December 2018 were collected. All patients underwent external drainage surgery. The follow-up time was more than 3 months. The clinical data of patients with relapse and non-recurrence were compared. Multivariate logistic regression was used to analyze the risk factors of recurrence in CSDH patients.

Results

Of the 113 patients, 10 had recurrence and 103 had no recurrence, and the recurrence rate was 8.8%. There were no significant differences in gender, age, preoperative hematoma thickness and midline deviation between the relapsed group and the non-recurrent group (P>0.05). The hematoma type and hematoma side of the relapsed group and the non-recurrent group were compared. The differences were statistically significant (P<0.05). Statistically significant variables in the univariate analysis were included in the logistic regression analysis. The results showed that preoperative stratification and bilateral hematoma were independent risk factors for CSDH recurrence.

Conclusion

The risk factors for the recurrence of CSDH are the types of hematoma separation and stratification and bilateral hematoma before imaging.

Key words: Chronic subdural hematoma, Recurrence, Radiological factors

表1 复发组和非复发组的相关因素比较

因素		复发组(n=10)	非复发组(n=103)	t/χ²值	P值
性别		?	?	0.002	0.965
?	男	8(80%)	83(81%)	?	?
?	女	2(20%)	20(19%)	?	?
年龄		61.9±7.6	64.7±20.7	-0.084	0.935
血肿的术前厚度(mm)		?	?	0.896	0.344
?	<20	2(20%)	42(41%)	?	?
?	≥20	8(80%)	61(59%)	?	?
血肿类型		?	?	21.820	<0.001
?	高密度	1(10%)	11(11%)	?	?
?	等密度	0(0%)	15(15%)	?	?
?	低密度	1(10%)	41(40%)	?	?
?	混合密度	2(20%)	27(26%)	?	?
?	分隔分层	6(60%)	9(9%)	?	?
中线偏移(mm)		?	?	0.456	0.500
?	<10	0(0%)	13(13%)	?	?
?	≥10	10(100%)	90(87%)	?	?
血肿侧别		?	?	3.920	0.048
?	单侧	6(60%)	91(88%)	?	?
?	双侧	4(40%)	12(12%)	?	?

表1 复发组和非复发组的相关因素比较

因素		复发组(n=10)	非复发组(n=103)	t/χ²值	P值
性别		?	?	0.002	0.965
?	男	8(80%)	83(81%)	?	?
?	女	2(20%)	20(19%)	?	?
年龄		61.9±7.6	64.7±20.7	-0.084	0.935
血肿的术前厚度(mm)		?	?	0.896	0.344
?	<20	2(20%)	42(41%)	?	?
?	≥20	8(80%)	61(59%)	?	?
血肿类型		?	?	21.820	<0.001
?	高密度	1(10%)	11(11%)	?	?
?	等密度	0(0%)	15(15%)	?	?
?	低密度	1(10%)	41(40%)	?	?
?	混合密度	2(20%)	27(26%)	?	?
?	分隔分层	6(60%)	9(9%)	?	?
中线偏移(mm)		?	?	0.456	0.500
?	<10	0(0%)	13(13%)	?	?
?	≥10	10(100%)	90(87%)	?	?
血肿侧别		?	?	3.920	0.048
?	单侧	6(60%)	91(88%)	?	?
?	双侧	4(40%)	12(12%)	?	?

表2 血肿术后复发因素Logistic回归分析

因素		偏回归系数	标准误	Wald值	OR值	95%CI	P值
血肿类型		?	?	?	?	?	?
?	非分隔	?	?	?	1(Ref)	?	?
?	分隔	3.705	1.406	2.636	40.658	-7.155~-0.990	0.008
血肿侧别		?	?	?	?	?	?
?	单侧	?	?	?	1(Ref)	?	?
?	双侧	3.964	1.475	2.687	52.646	1.133~7.795	0.007

表2 血肿术后复发因素Logistic回归分析

因素		偏回归系数	标准误	Wald值	OR值	95%CI	P值
血肿类型		?	?	?	?	?	?
?	非分隔	?	?	?	1(Ref)	?	?
?	分隔	3.705	1.406	2.636	40.658	-7.155~-0.990	0.008
血肿侧别		?	?	?	?	?	?
?	单侧	?	?	?	1(Ref)	?	?
?	双侧	3.964	1.475	2.687	52.646	1.133~7.795	0.007

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Analysis on imaging related factors of recurrence of chronic subdural hematoma

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Analysis on imaging related factors of recurrence of chronic subdural hematoma