DU Xiaolin, Wang Cheng, Jiao Rukai, Deng Xiaopeng, Chen Junquan, Zhou Chengming, Zhou Kun
The Jinyang Hospital Affiliated to Guizhou Medical University, Department of Neurosurgery, 550084, Guiyang, Guizhou Province, China.
Turk Neurosurg. 2025;35(4):644-651. doi: 10.5137/1019-5149.JTN.47482-24.2.
To evaluate association between chronic subdural hematoma (CSDH) and thromboelastography (TEG).
A prospective pilot study was conducted on 52 patients with CSDH. The primary outcomes were CSDH severity, recurrence rate, and outcome. The secondary outcome was the association between TEG parameters and the risk factors of CSDH.
The association between the preoperative TEG parameters and the primary outcomes was compared. Results revealed no statistically significant association between the primary outcomes and admission modified Rankin scale score and follow-up GOS score. The R values significantly differed between patients with recurrence and those without (p=0.045). Further subgroup analysis of TEG parameters revealed that patients with R values ≥ 5 had a significantly high incidence of recurrence (1.231, 95% confidence interval [CI]: 0.973-1.557], p=0.025). However, further logistic regression analysis did not reveal significant results (1.198, 95% CI: 0.855-1.680, p=0.293). Moreover, the association between the preoperative TEG parameters and the secondary outcomes was compared. Results revealed a statistically significant association between the secondary outcomes and hematoma thickness and LY30 values (p=0.039), midline shift and Angle (p=0.043), and multiplicity of the hematoma cavity and MA (p=0.022). Further, the secondary outcomes were also significantly associated with postoperative TEG parameters such as multiplicity of the hematoma cavity and LY 30 value (p=0.011) and residual hematoma at follow-up (MA, p=0.001).
Due to the small sample size, the efficacy of TEG parameters in predicting CSDH recurrence is unclear. However, TEG parameters are associated with the imaging characteristics of CSDH, and they can also be used to predict the absorption of hematoma. Nevertheless, large-scale prospective cohort studies should be performed to further validate the findings of this study.
评估慢性硬膜下血肿（CSDH）与血栓弹力图（TEG）之间的关联。
对52例CSDH患者进行了一项前瞻性初步研究。主要结局指标为CSDH严重程度、复发率和预后。次要结局指标为TEG参数与CSDH危险因素之间的关联。
比较了术前TEG参数与主要结局指标之间的关联。结果显示，主要结局指标与入院时改良Rankin量表评分及随访时GOS评分之间无统计学显著关联。复发患者与未复发患者的R值存在显著差异（p = 0.045）。对TEG参数进行进一步亚组分析发现，R值≥5的患者复发率显著较高（1.231，95%置信区间[CI]：0.973 - 1.557，p = 0.025）。然而，进一步的逻辑回归分析未得出显著结果（1.198，95% CI：0.855 - 1.680，p = 0.293）。此外，比较了术前TEG参数与次要结局指标之间的关联。结果显示，次要结局指标与血肿厚度和LY30值之间存在统计学显著关联（p = 0.039），与中线移位和Angle之间存在统计学显著关联（p = 0.043），与血肿腔的多发性和MA之间存在统计学显著关联（p = 0.022）。此外，次要结局指标还与术后TEG参数如血肿腔的多发性和LY 30值（p = 0.011）以及随访时的残余血肿（MA，p = 0.001）显著相关。
由于样本量较小，TEG参数在预测CSDH复发方面的有效性尚不清楚。然而，TEG参数与CSDH的影像学特征相关，并且还可用于预测血肿的吸收。尽管如此，仍应开展大规模前瞻性队列研究以进一步验证本研究的结果。
