目的:骨膜下脓肿(SPA)可导致毁灭性的发病率和死亡率。迅速的管理是重要的;然而,管理路线的选择是有争议的。这项研究调查了与手术管理相关的因素,并定义了提示手术干预的脓肿切断量。
方法:回顾了2014年至2023年向沙特国王大学医学城(KSUMC)提交的SPA病例。手术方法的研究与因素相关,包括年龄,性别,症状和体征,实验室结果,计算机断层扫描(CT)特征,药物,和手术方法。多重统计检验用于分析,包括学生t检验,卡方,多元logistic回归分析,和接收机工作特性(ROC)分析。
结果:患者接受药物治疗(n=14,45.16%)或手术治疗(n=17,54.84%)。抗生素的平均持续时间为15天。优越的SPA有利于手术治疗(OR=6.722,CI[1.332-33.913],p=0.029),随着类固醇的使用(OR=5.625,CI[0.915-34.572],p=0.049),和脓肿体积(OR=10.003,CI[1.418-70.540],p<0.001)。然而,在多因素logistic回归分析中,唯一的手术决定因素是脓肿体积(OR=5.126,CI[1.023-25.694],p=0.047)。SPA体积≥0.648ml强烈提示手术治疗,敏感性为94.1%,特异性为71.4%(p=0.000)。
结论:SPA体积使手术干预的可能性增加了五倍,特别是当脓肿体积≥0.648ml时。
OBJECTIVE: Subperiosteal abscess (SPA) can lead to devastating morbidity and mortality. Prompt management is important; however, the choice of management route is controversial. This study investigates factors associated with surgical management and defines a cut-off abscess volume prompting surgical intervention.
METHODS: SPA cases presented to King Saud University Medical City (KSUMC) from 2014 to 2023 were reviewed. The surgical approach was studied in association with factors including age, gender, symptoms and signs, laboratory results, computed tomography (CT) characteristics, medications, and surgical approach. Multiple statistical tests were used for analysis, including student t-test, chi-square, multiple logistic regression analysis, and receiver operating characteristic (ROC) analysis.
RESULTS: Patients were managed medically (n = 14, 45.16%) or surgically (n = 17, 54.84%). The average duration of antibiotics was 15 days. Superior SPA favors surgical management (OR = 6.722, CI [1.332-33.913], p = 0.029), along with the use of steroids (OR = 5.625, CI [0.915-34.572], p = 0.049), and abscess volume (OR = 10.003, CI [1.418-70.540], p < 0.001). However, the only factor attributing to a surgical decision on multivariate logistic regression analysis was abscess volume (OR = 5.126, CI [1.023-25.694], p = 0.047). SPA volume of ≥ 0.648 ml strongly prompts surgical management, with a sensitivity of 94.1% and a specificity of 71.4% (p = 0.000).
CONCLUSIONS: SPA volume increases the likelihood of surgical intervention by five times, especially when abscess volume is ≥ 0.648 ml.