中国医药
中國醫藥
중국의약
CHINA MEDICINE
2014年
12期
1780-1784
,共5页
汤可%赵亚群%周敬安%周青%刘策
湯可%趙亞群%週敬安%週青%劉策
탕가%조아군%주경안%주청%류책
颅骨缺损%颅骨修补术%咀嚼功能%危险因素%预后
顱骨缺損%顱骨脩補術%咀嚼功能%危險因素%預後
로골결손%로골수보술%저작공능%위험인소%예후
Calvarial defects%Cranioplasty%Masticatory function%Risk factors%Prognosis
目的 探讨颅骨修补术后发生咀嚼功能损害的危险因素.方法 回顾性分析2008年1月至2012年12月解放军第三○九医院神经外科去骨瓣减压术后颅骨缺损行颅骨修补术112例患者的临床资料,将性别、年龄、颅骨缺损面积、颅骨缺损时间、手术方式等列为影响因素,采用咀嚼肌无力/疼痛视觉模拟评分评估术后1个月时的咀嚼功能.通过Pearson x2检验筛选术后发生咀嚼功能损害的危险因素,经多因素Logistic回归分析确定独立危险因素.结果 术后1个月时发生咀嚼功能障碍43例(38.39％).年龄＜ 40岁对术后1个月时发生咀嚼肌无力与未发生咀嚼肌无力比较[23.0％ (17/74)比77.0％ (57/74)],差异有统计学意义(x2=5.625,P=0.018);发生疼痛与未发生疼痛比较[24.3％ (18/74)比75.7％ (56/74)],差异有统计学意义(x2=7.482,P=0.006);颅骨缺损面积≥60 cm2对术后1个月时,发生咀嚼肌无力与未发生咀嚼肌无力比较[72.4％ (21/29)比27.6％ (8/29)],差异有统计学意义(x2=32.739,P=0.000),发生疼痛与未发生疼痛比较[69.0％(20/29)比31.0％ (9/29)],差异有统计学意义(x2=22.836,P=0.000);颅骨缺损时间≥1年术后1个月时,发生咀嚼肌无力与未发生咀嚼肌无力比较[86.7％ (26/30)比13.3％ (4/30)],差异有统计学意义(x2=61.454,P=0.00),发生疼痛与未发生疼痛比较[80.0％ (24/30)比20.0％(6/30)],差异有统计学意义(x2 =40.854,P=0.00).非条件Logistic回归多因素分析显示颅骨缺损面积和时间分别为术后1个月时发生咀嚼肌无力[颅骨缺损面积比值比(OR) =11.179,95％置信区间(CI):2.572 ～48.582,P＜0.01);颅骨缺损时间(OR =51.741,95％ CI:12.27 ～218.25,P＜0.01)]和疼痛[颅骨缺损面积(OR=3.921,95％CI:1.23～12.52,P＜0.05);颅骨缺损时间(OR=14.388,95％CI:4.65 ～44.53,P＜0.01)]的独立危险因素.结论 去骨瓣减压术后早期行颅骨修补术有利于保护患者咀嚼功能,对于颅骨缺损面积大的患者术后应加强咀嚼功能锻炼.
目的 探討顱骨脩補術後髮生咀嚼功能損害的危險因素.方法 迴顧性分析2008年1月至2012年12月解放軍第三○九醫院神經外科去骨瓣減壓術後顱骨缺損行顱骨脩補術112例患者的臨床資料,將性彆、年齡、顱骨缺損麵積、顱骨缺損時間、手術方式等列為影響因素,採用咀嚼肌無力/疼痛視覺模擬評分評估術後1箇月時的咀嚼功能.通過Pearson x2檢驗篩選術後髮生咀嚼功能損害的危險因素,經多因素Logistic迴歸分析確定獨立危險因素.結果 術後1箇月時髮生咀嚼功能障礙43例(38.39％).年齡＜ 40歲對術後1箇月時髮生咀嚼肌無力與未髮生咀嚼肌無力比較[23.0％ (17/74)比77.0％ (57/74)],差異有統計學意義(x2=5.625,P=0.018);髮生疼痛與未髮生疼痛比較[24.3％ (18/74)比75.7％ (56/74)],差異有統計學意義(x2=7.482,P=0.006);顱骨缺損麵積≥60 cm2對術後1箇月時,髮生咀嚼肌無力與未髮生咀嚼肌無力比較[72.4％ (21/29)比27.6％ (8/29)],差異有統計學意義(x2=32.739,P=0.000),髮生疼痛與未髮生疼痛比較[69.0％(20/29)比31.0％ (9/29)],差異有統計學意義(x2=22.836,P=0.000);顱骨缺損時間≥1年術後1箇月時,髮生咀嚼肌無力與未髮生咀嚼肌無力比較[86.7％ (26/30)比13.3％ (4/30)],差異有統計學意義(x2=61.454,P=0.00),髮生疼痛與未髮生疼痛比較[80.0％ (24/30)比20.0％(6/30)],差異有統計學意義(x2 =40.854,P=0.00).非條件Logistic迴歸多因素分析顯示顱骨缺損麵積和時間分彆為術後1箇月時髮生咀嚼肌無力[顱骨缺損麵積比值比(OR) =11.179,95％置信區間(CI):2.572 ～48.582,P＜0.01);顱骨缺損時間(OR =51.741,95％ CI:12.27 ～218.25,P＜0.01)]和疼痛[顱骨缺損麵積(OR=3.921,95％CI:1.23～12.52,P＜0.05);顱骨缺損時間(OR=14.388,95％CI:4.65 ～44.53,P＜0.01)]的獨立危險因素.結論 去骨瓣減壓術後早期行顱骨脩補術有利于保護患者咀嚼功能,對于顱骨缺損麵積大的患者術後應加彊咀嚼功能鍛煉.
목적 탐토로골수보술후발생저작공능손해적위험인소.방법 회고성분석2008년1월지2012년12월해방군제삼○구의원신경외과거골판감압술후로골결손행로골수보술112례환자적림상자료,장성별、년령、로골결손면적、로골결손시간、수술방식등렬위영향인소,채용저작기무력/동통시각모의평분평고술후1개월시적저작공능.통과Pearson x2검험사선술후발생저작공능손해적위험인소,경다인소Logistic회귀분석학정독립위험인소.결과 술후1개월시발생저작공능장애43례(38.39％).년령＜ 40세대술후1개월시발생저작기무력여미발생저작기무력비교[23.0％ (17/74)비77.0％ (57/74)],차이유통계학의의(x2=5.625,P=0.018);발생동통여미발생동통비교[24.3％ (18/74)비75.7％ (56/74)],차이유통계학의의(x2=7.482,P=0.006);로골결손면적≥60 cm2대술후1개월시,발생저작기무력여미발생저작기무력비교[72.4％ (21/29)비27.6％ (8/29)],차이유통계학의의(x2=32.739,P=0.000),발생동통여미발생동통비교[69.0％(20/29)비31.0％ (9/29)],차이유통계학의의(x2=22.836,P=0.000);로골결손시간≥1년술후1개월시,발생저작기무력여미발생저작기무력비교[86.7％ (26/30)비13.3％ (4/30)],차이유통계학의의(x2=61.454,P=0.00),발생동통여미발생동통비교[80.0％ (24/30)비20.0％(6/30)],차이유통계학의의(x2 =40.854,P=0.00).비조건Logistic회귀다인소분석현시로골결손면적화시간분별위술후1개월시발생저작기무력[로골결손면적비치비(OR) =11.179,95％치신구간(CI):2.572 ～48.582,P＜0.01);로골결손시간(OR =51.741,95％ CI:12.27 ～218.25,P＜0.01)]화동통[로골결손면적(OR=3.921,95％CI:1.23～12.52,P＜0.05);로골결손시간(OR=14.388,95％CI:4.65 ～44.53,P＜0.01)]적독립위험인소.결론 거골판감압술후조기행로골수보술유리우보호환자저작공능,대우로골결손면적대적환자술후응가강저작공능단련.
Objective To evaluate risk factors of postoperative injury of masticatory function.Methods The clinical data of 112 cases undergoing cranioplasty for calvarial defects following decompressive craniotomy in the 309 hospital of PLA from January 2008 to December 2012 were analyzed retrospectively; gender,age,area of defect,duration of defect and surgical approach were analyzed as influencing factors.Masticatory function at one month after cranioplasty was evaluated by Visual Analogue Scale; Pearson Chi-square test was employed to select risk factors for masticatory dysfunction.Non-condition logistic regression analysis was employed to define the independent risk factors.Results There were 43 cases (38.4％) of postoperative masticatory dysfunction at one month following cranioplasty.Age ＜ 40 years was significantly related to postoperative masticatory fatigue [yes 23.0％ (17/74) versus no 77.0％ (57/74),x2 =5.625,P =0.018] and pain [yes 24.3％ (18/74) versus no 75.7 ％ (56/74),x2 =7.482,P =0.006].Area of defect ≥ 60 cm2 was significantly related to postoperative masticatory fatigue [yes 72.4％ (21/29) versus no 27.6％ (8/29),x2 =32.739,P =0.000] and pain [yes 69.0％ (20/29) versus no 31.0％ (9/29),x2 =22.836,P =0.000].Duration of defect ≥ 1 year was significantly related to postoperative masticatory fatigue [yes 86.7％ (26/30) versus no 13.3 ％ (4/30),x2 =61.454,P =0.000] and pain [yes 80.0％ (24/30) versus no 20.0％ (6/30),x2 =40.854,P =0.000].Area and duration of defect were independent risk factors for patients suffering masticatory muscle fatigue [area of defect (OR =11.179,95％ CI:2.572-48.582,P＜0.01) ; duration of defect (OR=51.741,95％CI:12.27-218.25,P＜0.01)] and pain [area of defect (OR =3.921,95％ CI:1.23-12.52,P ＜ 0.05) ; duration of defect (OR =14.388,95％ CI:4.65-44.53,P ＜0.01)] respectively by non-condition Logistic regression analysis.Conclusions Early cranioplasty following decompressive craniotomy is helpful to protect patient's masticatory function.Attention should be paid to patients with large area of defect to enhance masticatory functional exercise postoperatively.
