Wu Xiaohua, He Lingzhe, Shi Feina, Dong Fei, Zeng Qiang
Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Department of Neurology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
World Neurosurg. 2018 Jul;115:e688-e694. doi: 10.1016/j.wneu.2018.04.137. Epub 2018 Apr 27.
Prognostic markers are important for neurosurgeons to evaluate the indications for aggressive surgical management. The purpose of this study was to investigate whether the number of fractured calvarial bones could predict the outcome in patients with traumatic brain injury (TBI) after early craniotomy.
TBI patients who underwent early craniotomy were reviewed. The number of fractured calvarial bones was recorded by referring to preoperative computed tomographic (CT) images. Accordingly, patients were assigned to no calvarial fracture group, single calvarial fracture group, and multiple calvarial fractures group. Good outcome was defined as Glasgow Outcome Scale scores of 4 and 5 at discharge. Logistic regression analyses were used to assess the effect of calvarial fracture on outcome. A receiver operating characteristic curve was generated for the final model.
In all, a total of 141 patients were enrolled. Patients with no calvarial fracture had a significantly lower rate of good outcome (12.5%) than did those with a single calvarial fracture (62.2%, P < 0.001) and those with multiple calvarial fractures (48.6%, P = 0.005). Binary logistic regression showed that the number of fractured calvarial bones was an independent imaging marker for predicting outcome (P = 0.003) after adjustment for age, Glasgow Coma Scale score on admission, and decompressive craniectomy. The area under the curve of the final model was 0.863.
The number of fractured calvarial bones is an independent predictor of outcome in TBI patients after early craniotomy. No calvarial facture is associated with poor outcome in these patients.
预后标志物对于神经外科医生评估积极手术治疗的适应症非常重要。本研究的目的是调查颅骨骨折的数量是否可以预测早期开颅术后创伤性脑损伤（TBI）患者的预后。
回顾性分析接受早期开颅手术的TBI患者。通过术前计算机断层扫描（CT）图像记录颅骨骨折的数量。据此，将患者分为无颅骨骨折组、单处颅骨骨折组和多处颅骨骨折组。良好预后定义为出院时格拉斯哥预后量表评分为4分和5分。采用逻辑回归分析评估颅骨骨折对预后的影响。为最终模型生成受试者工作特征曲线。
总共纳入了141例患者。无颅骨骨折患者的良好预后率（12.5%）明显低于单处颅骨骨折患者（62.2%，P < 0.001）和多处颅骨骨折患者（48.6%，P = 0.005）。二元逻辑回归显示，在调整年龄、入院时格拉斯哥昏迷量表评分和减压性颅骨切除术后，颅骨骨折的数量是预测预后的独立影像标志物（P = 0.003）。最终模型的曲线下面积为0.863。
颅骨骨折的数量是早期开颅术后TBI患者预后的独立预测因素。在这些患者中，无颅骨骨折与预后不良相关。
