颞肌厚度与慢性硬膜下血肿患者钻孔引流术后复发的关系研究

doi:10.3877/cma.j.issn.2095-9141.2025.03.006

目的

分析颞肌厚度（TMT）与接受钻孔引流手术的慢性硬膜下血肿（CSDH）患者术后复发的关系。

方法

回顾性分析太和县人民医院神经外科自2021年1月至2023年12月接受钻孔引流术的108例CSDH患者的临床资料，术前行头部CT扫描测量TMT。将患者按性别分层，比较男性与女性的TMT。受试者工作特征（ROC）曲线和最大化约登指数确定TMT的性别特异性临界值，根据该临界值将患者分为低颞肌厚度（LTMT）组和高颞肌厚度（HTMT）组，比较2组患者的临床资料。根据患者术后6个月是否复发，分为复发组和未复发组。采用多因素Logistic回归分析筛选CSDH患者术后复发的独立危险因素。

结果

108例患者中，复发组19例，未复发组89例。男性患者的TMT显著高于女性，差异有统计学意义（P<0.05）。ROC曲线分析显示，预测复发的最佳TMT临界值为男性4.175 mm，女性3.300 mm。HTMT组56例，LTMT组52例，LTMT组患者的复发率高于HTMT组，差异有统计学意义（P<0.05）。多因素Logistic回归分析显示，年龄≥70岁、TMT≤临界值（男性4.175 mm，女性3.300 mm）及血肿量是CSDH患者术后复发的独立危险因素。

结论

术前TMT低于性别特异性临界值是CSDH患者钻孔引流术后复发的独立危险因素，其预测价值不受年龄与血肿量影响，有助于识别高复发风险的患者。

关键词: 颞肌厚度, 慢性硬膜下血肿, 钻孔引流术, 复发

Objective

To analyze the correlation between temporal muscle thickness (TMT) and postoperative recurrence in patients with chronic subdural hematoma (CSDH) who underwent burr hole drainage.

Methods

A retrospective analysis was conducted on the clinical data of 108 CSDH patients who received burr hole drainage in the Neurosurgery Department of Taihe County People's Hospital from January 2021 to December 2023. TMT was measured by preoperative head CT scan. Patients were stratified by gender, and their TMT was compared between males and females. The receiver operating characteristic (ROC) curve and maximum Jordan index were used to determine the gender specific threshold for TMT. Based on this threshold, patients were divided into a low temporal muscle thickness (LTMT) group and a high temporal muscle thickness (HTMT) group, and their clinical data were compared between the two groups. According to whether the patient has a recurrence 6 months after surgery, they were divided into a recurrence group and a non-recurrence group. Adopting multiple Logistic regression analysis to identify independent risk factors for postoperative recurrence in CSDH patients.

Results

Among the 108 patients, there were 19 patients in the recurrence group and 89 patients in the non-recurrence group. The TMT of male patients was significantly higher than that of females, and the difference was statistically significant (P<0.05). ROC curve analysis showed that the optimal TMT threshold for predicting recurrence was 4.175 mm for males and 3.300 mm for females. There were 56 cases in the HTMT group and 52 cases in the LTMT group. The recurrence rate of patients in the LTMT group was higher than that in the HTMT group, and the difference was statistically significant (P<0.05). Multivariate Logistic regression analysis showed that age ≥70 years, TMT≤critical value (4.175 mm for males and 3.300 mm for females), and hematoma volume were independent risk factors for postoperative recurrence in CSDH patients.

Conclusions

Preoperative TMT below the gender specific threshold is an independent risk factor for postoperative recurrence in CSDH patients, and its predictive value is not affected by age and hematoma volume, which helps identify patients at high risk of recurrence.

Key words: Temporal muscle thickness, Chronic subdural hematoma, Burr hole drainage, Recurrence

图1 慢性硬膜下血肿患者的影像学资料A：颞肌厚度（白色箭头）是垂直于颅骨切面（黄线）的颞肌最厚部分（红线）；B：中线偏移（红线）是透明隔与矢状线（黄线）在侧脑室水平面上的最长垂直距离

Fig.1 Imaging of patients with chronic subdural hematoma

表1 2组CSDH患者的临床资料比较

Tab.1 Comparison of clinical data between two groups of CSDH patients

项目	复发组（n=19）	未复发组（n=89）	χ²/Z/t值	P值
年龄[例（%）]			7.347	0.007
≥70岁	18（94.7）	56（63.9）
<70岁	1（5.3）	33（37.1）
性别（男/女）	16/3	67/22	0.702	0.402
TMT[mm，M（IQR）]	3.45（1.33）	4.15（1.25）	-2.336	0.019
血肿量（mL，±s）	85.30±29.91	101.16±28.49	2.095	0.039
BMI（mm，±s）	25.75±5.27	26.04±5.03	0.226	0.822
抗凝或抗血小板药物使用史[例（%）]	1（5.3）	2（2.2）	0.527	0.468
APTT（mm，±s）	30.79±5.05	31.58±5.64	0.562	0.575
血肿分隔[例（%）]	2（10.5）	4（4.5）	1.086	0.297
中线偏移（mm，±s）	9.28±1.83	8.75±2.15	0.987	0.326

表1 2组CSDH患者的临床资料比较

Tab.1 Comparison of clinical data between two groups of CSDH patients

项目	复发组（n=19）	未复发组（n=89）	χ²/Z/t值	P值
年龄[例（%）]			7.347	0.007
≥70岁	18（94.7）	56（63.9）
<70岁	1（5.3）	33（37.1）
性别（男/女）	16/3	67/22	0.702	0.402
TMT[mm，M（IQR）]	3.45（1.33）	4.15（1.25）	-2.336	0.019
血肿量（mL，±s）	85.30±29.91	101.16±28.49	2.095	0.039
BMI（mm，±s）	25.75±5.27	26.04±5.03	0.226	0.822
抗凝或抗血小板药物使用史[例（%）]	1（5.3）	2（2.2）	0.527	0.468
APTT（mm，±s）	30.79±5.05	31.58±5.64	0.562	0.575
血肿分隔[例（%）]	2（10.5）	4（4.5）	1.086	0.297
中线偏移（mm，±s）	9.28±1.83	8.75±2.15	0.987	0.326

图2 基于颞肌厚度预测不同性别CSDH患者复发风险的特异性受试者工作特性曲线A：男性；B：女性；CSDH：慢性硬膜下血肿

Fig.2 Specific receiver operating characteristic curve for predicting the recurrence risk of CSDH patients of different genders based on temporal muscle thickness

表2 测量者内和测量者间的可靠性分析

Tab.2 Reliability analysis of intra and inter observers

分组	ICC（95%CI）
测量者内
测量者1.1 vs测量者1.2	0.960（0.921~0.982）
测量者2.1 vs测量者2.2	0.942（0.891~0.973）
测量者间
测量者1.1 vs测量者2.1	0.973（0.942~0.981）
测量者1.2 vs测量者2.2	0.951（0.912~0.970）
测量者1.1 vs测量者2.2	0.983（0.953~0.991）
测量者1.2 vs测量者2.1	0.931（0.861~0.960）

表2 测量者内和测量者间的可靠性分析

Tab.2 Reliability analysis of intra and inter observers

分组	ICC（95%CI）
测量者内
测量者1.1 vs测量者1.2	0.960（0.921~0.982）
测量者2.1 vs测量者2.2	0.942（0.891~0.973）
测量者间
测量者1.1 vs测量者2.1	0.973（0.942~0.981）
测量者1.2 vs测量者2.2	0.951（0.912~0.970）
测量者1.1 vs测量者2.2	0.983（0.953~0.991）
测量者1.2 vs测量者2.1	0.931（0.861~0.960）

表3 HTMT组与LTMT组CSDH患者的临床资料比较

Tab.3 Comparison of clinical data of patients in HTMT group and LTMT group

项目	HTMT组（n=56）	LTMT组（n=52）	χ²/t值	P值
年龄[例（%）]			3.284	0.070
≥70岁	34（60.7）	40（76.9）
<70岁	22（29.2）	12（23.1）
性别（男/女）	45/11	38/14	0.803	0.370
复发[例（%）]	4（7.1）	15（28.8）	8.718	0.003
血肿量（mL，±s）	92.20±30.86	85.27±29.52	1.167	0.246
术前中线偏移（mm，±s）	8.81±2.30	8.89±1.88	0.199	0.843

表3 HTMT组与LTMT组CSDH患者的临床资料比较

Tab.3 Comparison of clinical data of patients in HTMT group and LTMT group

项目	HTMT组（n=56）	LTMT组（n=52）	χ²/t值	P值
年龄[例（%）]			3.284	0.070
≥70岁	34（60.7）	40（76.9）
<70岁	22（29.2）	12（23.1）
性别（男/女）	45/11	38/14	0.803	0.370
复发[例（%）]	4（7.1）	15（28.8）	8.718	0.003
血肿量（mL，±s）	92.20±30.86	85.27±29.52	1.167	0.246
术前中线偏移（mm，±s）	8.81±2.30	8.89±1.88	0.199	0.843

表4 CSDH患者术后复发的多因素Logistic回归分析

Tab.4 Multivariate Logistic regression analysis of postoperative recurrence in CSDH patients

变量	偏回归系数	标准误	Wald值	P值	OR值	95%CI
年龄≥70岁	2.221	1.075	4.267	0.039	9.220	1.503~18.857
TMT≤临界值^a	1.672	0.645	6.718	0.010	5.324	1.120~75.868
血肿量	0.021	0.010	4.532	0.033	1.021	1.002~1.041
常量	-6.363	1.570	16.433	0.000	0.002

表4 CSDH患者术后复发的多因素Logistic回归分析

Tab.4 Multivariate Logistic regression analysis of postoperative recurrence in CSDH patients

变量	偏回归系数	标准误	Wald值	P值	OR值	95%CI
年龄≥70岁	2.221	1.075	4.267	0.039	9.220	1.503~18.857
TMT≤临界值^a	1.672	0.645	6.718	0.010	5.324	1.120~75.868
血肿量	0.021	0.010	4.532	0.033	1.021	1.002~1.041
常量	-6.363	1.570	16.433	0.000	0.002

[1]	Maroufi SF, Farahbakhsh F, Macdonald RL, et al. Risk factors for recurrence of chronic subdural hematoma after surgical evacuation: a systematic review and meta-analysis[J]. Neurosurg Rev, 2023, 46(1): 270. DOI: 10.1007/s10143-023-02175-1.
[2]	Bounajem MT, Campbell RA, Denorme F, et al. Paradigms in chronic subdural hematoma pathophysiology: current treatments and new directions[J]. J Trauma Acute Care Surg, 2021, 91(6): e134-e141. DOI: 10.1097/ta.0000000000003404.
[3]	胡凯,张华.慢性硬膜下血肿发病机制及治疗的研究进展[J].临床神经外科杂志, 2024, 21(1): 102-105, 109. DOI: 10.3969/j.issn.1672-7770.2024.01.020.
[4]	赵国政,刘超,钱冬喜,等.衰老相关分泌表型在复发慢性硬膜下血肿患者中表达及其预测模型构建[J].中国老年学杂志, 2024, 44(11): 2600-2603.
[5]	Li CW, Yu K, Shyh-Chang N, et al. Pathogenesis of sarcopenia and the relationship with fat mass: descriptive review[J]. J Cachexia Sarcopenia Muscle, 2022, 13(2): 781-794. DOI: 10.1002/jcsm.12901.
[6]	Dubinski D, Won SY, Behmanesh B, et al. Significance of temporal muscle thickness in chronic subdural hematoma[J]. J Clin Med, 2022, 11(21): 6456. DOI: 10.3390/jcm11216456.
[7]	Jeon GJ, Rim HT, Lee HS, et al. Factors for predicting recurrence after burr hole drainage for chronic subdural hematoma: a retrospective study[J]. Neurosurg Rev, 2023, 46(1): 306. DOI: 10.1007/s10143-023-02222-x.
[8]	Wilkinson DJ, Piasecki M, Atherton PJ. The age-related loss of skeletal muscle mass and function: measurement and physiology of muscle fibre atrophy and muscle fibre loss in humans[J]. Ageing Res Rev, 2018, 47: 123-132. DOI: 10.1016/j.arr.2018.07.005.
[9]	Won SY, Zagorcic A, Dubinski D, et al. Excellent accuracy of ABC/2 volume formula compared to computer-assisted volumetric analysis of subdural hematomas[J]. PLoS One, 2018, 13(6): e0199809. DOI: 10.1371/journal.pone.0199809.
[10]	Kipele M, Buchfelder M, Taudte RV, et al. Immunometabolic profiling of chronic subdural hematoma through untargeted mass spectrometry analysis: preliminary findings of a novel approach[J]. Diagnostics (Basel), 2023, 13(21): 3345. DOI: 10.3390/diagnostics13213345.
[11]	Jensen TSR, Andersen-Ranberg N, Poulsen FR, et al. The Danish chronic subdural hematoma study-risk factors for second recurrence [J]. World Neurosurg, 2022, 168: e178-e186. DOI: 10.1016/j.wneu.2022.09.072.
[12]	曹文钰,郭鹏,李锦平.微创手术及非手术方式治疗慢性硬膜下血肿的研究进展[J].中华神经创伤外科电子杂志, 2024, 10(5): 304-309. DOI: 10.3877/cma.j.issn.2095-9141.2024.05.008.
[13]	Edlmann E, Giorgi-Coll S, Whitfield PC, et al. Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and implications for pharmacotherapy[J]. J Neuroinflammation, 2017, 14(1): 108. DOI: 10.1186/s12974-017-0881-y.
[14]	王如海,孙菲琳,杨震,等.硬膜下积液厚度对创伤性硬膜下积液转化为慢性硬膜下血肿的预测价值[J].中华脑科疾病与康复杂志(电子版), 2021, 11(4): 227-231. DOI: 10.3877/cma.j.issn.2095-123X.2021.04.008.
[15]	Weigel R, Schilling L, Krauss JK. The pathophysiology of chronic subdural hematoma revisited: emphasis on aging processes as key factor[J]. Geroscience, 2022, 44(3): 1353-1371. DOI: 10.1007/s11357-022-00570-y.
[16]	Uyar B, Palmer D, Kowald A, et al. Single-cell analyses of aging, inflammation and senescence[J]. Ageing Res Rev, 2020, 64: 101156. DOI: 10.1016/j.arr.2020.101156.
[17]	Li X, Li C, Zhang W, et al. Inflammation and aging: signaling pathways and intervention therapies[J]. Signal Transduct Target Ther, 2023, 8(1): 239. DOI: 10.1038/s41392-023-01502-8.
[18]	Birch J, Gil J. Senescence and the sasp: many therapeutic avenues[J]. Genes Dev, 2020, 34(23-24): 1565-1576. DOI: 10.1101/gad.343129.120.
[19]	Ouvrier B, Ismael S, Bix GJ. Senescence and SASP are potential therapeutic targets for ischemic stroke[J]. Pharmaceuticals (Basel), 2024, 17(3): 312. DOI: 10.3390/ph17030312.
[20]	He Y, Xie W, Li H, et al. Cellular senescence in sarcopenia: possible mechanisms and therapeutic potential[J]. Front Cell Dev Biol, 2021, 9: 793088. DOI: 10.3389/fcell.2021.793088.
[21]	Englund DA, Zhang X, Aversa Z, et al. Skeletal muscle aging, cellular senescence, and senotherapeutics: current knowledge and future directions[J]. Mech Ageing Dev, 2021, 200: 111595. DOI: 10.1016/j.mad.2021.111595.
[22]	Tuttle CSL, Thang LAN, Maier AB. Markers of inflammation and their association with muscle strength and mass: a systematic review and meta-analysis[J]. Ageing Res Rev, 2020, 64: 101185. DOI: 10.1016/j.arr.2020.101185.
[23]	Dalle S, Rossmeislova L, Koppo K. The role of inflammation in age-related sarcopenia[J]. Front Physiol, 2017, 8: 1045. DOI: 10.3389/fphys.2017.01045.
[24]	Bian AL, Hu HY, Rong YD, et al. A study on relationship between elderly sarcopenia and inflammatory factors IL-6 and TNF-α[J]. Eur J Med Res, 2017, 22(1): 25. DOI: 10.1186/s40001-017-0266-9.
[25]	Frasca D, Blomberg BB. Inflammaging decreases adaptive and innate immune responses in mice and humans[J]. Biogerontology, 2016, 17(1): 7-19. DOI: 10.1007/s10522-015-9578-8.
[26]	Tolonen A, Pakarinen T, Sassi A, et al. Methodology, clinical applications, and future directions of body composition analysis using computed tomography (CT) images: a review[J]. Eur J Radiol, 2021, 145: 109943. DOI: 10.1016/j.ejrad.2021.109943.
[27]	Korhonen TK, Arponen O, Steinruecke M, et al. Reduced temporal muscle thickness predicts shorter survival in patients undergoing chronic subdural haematoma drainage[J]. J Cachexia Sarcopenia Muscle, 2024, 15(4): 1441-1450. DOI: 10.1002/jcsm.13489.

[1]	汪浪, 何怡华, 李征毅, 刘翠云, 颉剑锋, 陈健. 母胎超声参数对复发性流产孕妇不良妊娠结局的预测价值[J/OL]. 中华医学超声杂志（电子版）, 2025, 22(06): 556-563.
[2]	明昊, 宋宏萍, 白誉誉, 党晓智, 赵阳, 程燕妮, 王琪, 肖迎聪. 自动乳腺超声联合临床病理特征预测Luminal B 型乳腺癌术后复发风险的临床研究[J/OL]. 中华医学超声杂志（电子版）, 2025, 22(04): 337-347.
[3]	王晨曦, 姚心怡, 石汪琼, 杜丽萍. 乳腺癌患者复发风险感知的研究进展[J/OL]. 中华乳腺病杂志(电子版), 2025, 19(03): 179-181.
[4]	地力木热提·艾买提, 于鹏, 丁志翔, 段绍斌. 胆总管直径与肝内Ⅰ、Ⅱ级胆管直径的比值对胆总管结石复发的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(05): 559-561.
[5]	王珂, 岳育民, 武珍珍, 许泽宇, 惠晓辉, 赵云, 窦维佳, 赵青川. 腹腔镜经自然腔道手术对结直肠癌患者肠道功能及远期效果的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 413-416.
[6]	袁强, 向文瑞, 吕远, 闫璋哲, 朱含放, 陈光, 孙亮, 陈纲, 赵锁. 基于随机生存森林的胃肠道间质瘤无复发生存期预测模型研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 438-441.
[7]	赵晨皓, 张序东, 杨浚沫, 周何. 血清肿瘤标志物对结直肠癌患者术后复发的预测效能研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 467-470.
[8]	胡媛媛, 孙文萍, 杨丹, 方道成. 尿THP和24小时尿渗透压对草酸钙结石患者复发的预测价值[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(04): 460-464.
[9]	甘廷彬, 秦韬. SSIGN分级联合γ-谷氨酰转肽酶在高危非转移性肾癌术后复发的预测价值[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(04): 476-482.
[10]	廖俊豪, 周理林, 曾健文. 广东省医学会泌尿外科疑难病例多学科会诊（第25期）——膀胱癌根治术后盆腔复发[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(03): 390-394.
[11]	徐燕楠, 胡成宇, 花荣. 围手术期放射治疗在可切除腹膜后肉瘤治疗中的价值[J/OL]. 中华疝和腹壁外科杂志(电子版), 2025, 19(04): 377-382.
[12]	张鸣凤, 侯莉莉, 党萍, 马清艳, 康冠楠, 李志强, 陈倩倩, 张盼盼, 陈莹莹, 张楠楠. 复治耐多药/利福平耐药肺结核复发影响因素探讨[J/OL]. 中华肺部疾病杂志(电子版), 2025, 18(03): 406-410.
[13]	龙吟, 何晓东, 廖建国, 黄珏, 张磊. 高复发风险肝癌患者术后靶向免疫治疗的安全性及疗效[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(03): 379-386.
[14]	郑秉礼, 彭洁, 孟塬. KRAS基因突变对可切除胰腺癌临床预后的影响[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(03): 456-462.
[15]	曹聪, 董伟, 徐良斌, 付雍. 成人肝母细胞瘤长期存活一例[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(03): 471-474.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Correlation study between temporal muscle thickness and recurrence in patients with chronic subdural hematoma after burr hole drainage

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Correlation study between temporal muscle thickness and recurrence in patients with chronic subdural hematoma after burr hole drainage