Objective To analyze the correlation and clinical significance between early hematoma expansion in cerebral injury hemorrhage and rebleeding after stereotactic puncture surgery.

Methods A total of 245 patients with cerebral injury hemorrhage admitted to the First Affiliated Hospital of Hunan University of Chinese Medicine from January 2021 to January 2025 were selected as the study subjects, all of whom underwent stereotactic puncture surgery. According to whether rebleeding occurred after surgery, the patients were divided into rebleeding group and non-rebleeding group. Clinical data, laboratory indicators, hematoma expansion status, and cranial CT hematoma imaging signs were compared between the two groups. Binary logistic regression analysis was used to identify risk factors influencingrebleeding after stereotactic puncture surgery for cerebral injury. Based on multivariate analysis of risk factors, a nomogram model for predicting the risk of postoperative rebleeding was further constructed, and its predictive performance was evaluated.

Results Statistically significant differences were observed between the rebleeding group and the non-rebleeding group in terms of the time from onset to surgery, preoperative hematoma volume, rupture into the ventricle, hematomaexpansion, hematoma shape, CT black hole sign, and CT mixed sign (P < 0.05). Binary logistic regression analysis revealed that the time from onset to surgery (OR=3.213, 95%CI: 1.602 to 6.444), reoperative hematoma volume (OR=1.119, 95%CI: 1.060 to 1.181), hematoma expansion (OR=5.033, 95%CI: 2.548 to 9.942), irregular hematoma shape (OR=3.738, 95%CI: 1.799 to 7.765), and CT black hole sign (OR=2.447, 95%CI: 1.248 to 4.799) were independent risk factors for rebleeding after stereotactic puncture surgery in patients with cerebral injury hemorrhage (P < 0.05). The constructed nomogram model for predicting postoperative rebleeding demonstrated an AUC value of 0.857 (0.758 to 0.892), indicating good diagnostic consistency and clinical benefit, with a good fit according to the Hosmer-Lemeshow test (P>0.05).

Conclusion Constructing a nomogram for predicting the risk of rebleeding after stereotactic puncture surgery based on early hematoma expansion, irregular hematoma shape, CT black hole sign, and other imaging signs is beneficial for identifying patients with cerebral injury hemorrhage at high risk of postoperative rebleeding, improving the accuracy of clinical assessment, and providing guidance for formulating targeted treatment plans and improving patient prognosis.