自体骨瓣、普通钛网、预塑二维钛网修补颅骨缺损比较

目的 比较自体骨瓣、普通钛网和预塑二维钛网修补颅骨缺损的临床效果.方法 回顾性分析2005年7月至2011年3月行颅骨修补术340例患者的临床资料,其中使用自体骨瓣修补168例、普通钛网122例和预塑二维钛网45例.结果 普通钛网组单侧颅骨缺损修补时间(92.5 min)和预塑二维钛网组(85 min)较自体骨瓣组(65 min)明显延长(P<0.05).三组之间术后并发症如头皮下感染、材料外露、再手术取出材料、癫痫、颅内血肿和皮下积液等发生率均无明显差异(P>0.05);而自体骨瓣组术后外观缺陷率最高,普通钛网组次之,预塑二维钛网组最低,三组之间差异均明显(P<0.05).结论 自体骨瓣、普通钛网和预塑二维钛网等材料与颅骨成形术后感染、癫痫、颅内出血等无明显相关性;额颞颅骨缺损首选预塑二维钛网,非额颞颅骨缺损修补应首选自体骨瓣;普通钛网逐渐淘汰,但可使用于颅骨缺损急诊一期修补.

Comparison among repair effects of autologous skull bone flap, common titanium mesh and pre-modeled two-dimensional titanium mesh on skull defects

Objective To compare the repair effect of autologous skull bone flap on skull bone defects with those of common titanium mesh or pre-modeled two-dimensional titanium mesh. Methods Of 335 patients with skull bone defects, 168 received autologous skull bone flap cranioplasty, 122 common titanium mesh cranioplasty and 45 pre-modeled two-dimensional titanium mesh cranioplasty. The operation duration, postoperative shape defects and operative complications were analyzed and compared. Results The operative duration in the autologous skull bone flap cranioplasty group was significantly shorter than those in the pre-modeled two-dimensional titanium mesh and the common titanium mesh cranioplasty groups ( P <0.05). The rate (17.9% ) of the postoperative shape defect in the autologous skull bone flap cranioplasty group was significantly higher than that (9.0%) in the common titanium mesh cranioplasty ( P <0.05) which was significantly higher than that (0.0%) in the pre-modeled two-dimensional titanium mesh cranioplasty group ( P <0.05). There were no significant differences in the rates of the postoperative infection, the occurrent of the postoperative epilepsy and intracranial hemorrhage among three groups ( P >0.05). Conclusions It is suggested that the postoperative infection, epilepsy and intracranial hemorrhage may be not related to the repair materials including the autologous skull bone flap, common titanium mesh and pre-modeled two-dimensional titanium mesh. The pre-modeled two-dimensional titanium mesh should be preferable to the autologous skull bone flap and common titanium mesh in the patients with frontotemporal skull bone defects. The autologous skull bone flap should be used first to repair non-frontotemporal skull bone defects. The common titanium mesh for the cranioplasty is gradually eliminated, but it may be used for the emergency repair of the skull bone defect.