钛网与硅胶网板材料在行颅骨成形修补中的应用：组织相容性比较

目的：比较钛网与硅胶网板在颅骨成形手术中应用的优缺点，以及近远期材料与宿主的组织相容性。方法：选择1996—11／2007—10滦南县医院神经外科收治的颅骨缺损患者124例，应用钛网材料修补患者63例，应用硅胶网板材料修补患者61例。①硅胶网板：上海橡胶制品研究所生产。术前按颅骨缺损所需大小及形状，比缺损大出5mm剪下，熏蒸或浸泡消毒。术中应用时按需要剪取相应部位，边缘四周修剪成斜坡状，嵌入颅骨缺损处，用10号医用丝线或银丝捆绑固定。②钛网：德国贝朗＼蛇牌S90027。术前高温消毒，备手术时用。术中显露缺损骨窗后，按缺损骨窗所需大小及形状塑型后，比缺损骨窗大出10mm剪下，覆盖在缺损骨窗上，四周用钛钉固定。2006年后使用的均为数字塑型，大小形状均由厂家据术前三维CT一次成型。观察两种材料修补颅骨缺损近期和远期效果及两种材料应用后的不良反应。结果：随访1个月者5例，3个月者16例，半年者21例，1-5年者53例，6～11年者29例。①近期效果：124例术后2～7d应用硅胶网板61例中皮下积液21例，脑脊液漏3例，头皮血肿2例，局部疼痛7例：应用钛网63例中皮下积液7例，头皮血肿1例，局部疼痛4例。28例积液者积液约10～80mL，皮下积液与缺损区大小及材料有关，经1-4次穿刺抽液、加压包扎后Ⅰ期愈合。脑脊液漏3例，均为切口漏，经缝合加压包扎1周内痊愈。头皮血肿3例，因量小自行吸收。手术创口均达到Ⅰ期愈合，局部疼痛11例，能忍受未行特殊处理。②远期效果：癫痫2例给与口服苯妥英钠后未再发生。③并发症比较：应用硅胶网板材料患者的并发症发生率明显高于应用钛网材料的患者，差异有显著性（x^2=21．42，P〈0．01）。124例患者均未发生感染、植入片折裂以及排异反应。结论：使用钛网作为颅骨缺

Application of titanium mesh and silica gel plate in clinical cranioplasty： A comparison of histocompatibility

AIM： To compare the advantages and disadvantages of titanium mesh and silica gel plate used for clinical cranioplasty and histocompatibility between material and host in short and long term. METHODS： The data of 124 patients undergone cranioplasty from November 1996 to October 2007 at the Department of Neurosurgery, Luannan Prefectural Hospital was analyzed by retrospective review. Among them, 63 patients applied titanium mesh and 61 applied silica gel. 1.Silica gel plate was produced by Shanghai Rubber Goods Institute. Before the surgery, the plate was cut according to the size and shape of the defected skull （usually 5 mm larger than the defect）, and then disinfected by steaming or soaking. During the surgery, the plate was cut as required with its edge cut into the slope and embedded in the skull defect, and then fixed with the 10th Medical silver thread or silver wire.2.Titanium mesh was Germany Beilang/She brand S90027. Preoperative high-temperature disinfection was done on titanium mesh and prepared for the surgery. During the surgery, when the skull defect was exposed, the titanium mesh was cut and shaped by the required size and shape （10 mm larger than the defect）. Then it was used to cover the defect and fixed around with titanium screws. Since 2006, digital shaping has been used, and the titanium mesh is molded by the manufacturers according to the preoperative 3D-CT. The short and long-term effects as well as adverse reactions were observed after application of the two materials. RESULTS： Five cases were followed up for 1 month, sixteen cases for 3 months, twenty-one cases for half a year, fifty-three cases for 1-5 years and twenty-nine cases for 6-11 years. 1.Short-term effects： 2 to 7 days after the surgery, of 61 applied silica gel, subcutaneous fluid occurred in 21 patients, leakage of cerebrospinal fluid in 3 cases, scalp hematoma in 2 cases and regional pain in 7 cases. Of 63 patients applied titanium mesh, subcutaneous fluid occurred in 7 patients, scalp hematoma in 1 cases and