自体颅骨在颅骨缺损修补术中的应用价值

目的探讨基层医院冷冻保存的自体颅骨在颅骨缺损修补术中的价值。方法 65例患者去骨瓣获得颅骨置于无菌塑料袋保存-10℃冰箱,术后3~6个月患者适合做颅骨修补时,取出冻存的颅骨,在常温解冻后高压蒸汽灭菌,术中原位回置,术后定期随诊。结果全部一期愈合,1例出现血肿后,再次钛网修补;1例松动吸收;半年后感染2例,出现皮下积液,均吸收恢复;癫痫1例,经药物治疗获得控制。结论冷冻保存的自体颅骨安全、可靠用于颅骨修补,外观上更接近解剖学特点,更能接近容貌,且费用低,患者易于接受,值得基层医院推广。     

冷冻保存自体颅骨行颅骨修补术56例临床分析

目的探讨应用普通冰箱冷冻室保存开颅手术中取下的自体颅骨,灭菌、钻孔、回植的可行性和优越性。 方法本研究选取自2006年5月至2010年11月廊坊市第四人民医院神经外科收治的56例患者,去骨瓣减压术后颅骨瓣无菌保存于普通冰箱冷冻室,二期修补手术时将自体颅骨取出后自然复温,放入碘伏液中浸泡消毒2 h,后用双氧水浸泡2 h,然后用生理盐水反复冲洗,并用骨科常用直径3 mm克氏针钻头按1个/mm²的距离将消毒后的颅骨进行钻孔,后回植于患者体内,用颅骨锁固定于正常颅骨上。观察临床效果,并对患者定期颅脑CT复查随访。 结果通过对56例患者的游离骨瓣进行普通冰箱冷冻保存,3个月后再行颅骨修补的临床观察,发现骨瓣能完全解剖复位,与周围骨窗骨性愈合良好,外形美观,无排斥反应等并发症及任何不良反应。 结论自体颅骨冷冻保存后灭菌再植是一种经济、简便、效果良好、值得推广的好方法,灭菌自体颅骨是颅骨修补的理想材料。     

颅脑损伤后自体颅骨修补术的临床探讨（附32例报告）

目的探讨冷冻保存的自体颅骨在颅骨缺损修补术中的应用价值。方法将去骨瓣减压获得的颅骨密封于三层无菌塑料袋，保存于-70℃冰箱。术后3周～7月，患者适合做颅骨成形术时，取出冻存的颅骨，在常温解冻后复位固定于原骨窗。术后定期随访，观察头颅外观：并利用X线和CT扫描观察骨瓣缘的吸收情况。结果32例手术均获得成功，无皮下积液、感染等并发症，患者恢复快；头颅外形与伤前一致，长期随访未发现明显骨吸收，且费用低。结论冷冻保存的自体颅骨可以安全、可靠地用于颅骨修补，值得推广。     

自体颅骨瓣移植于髂骨外板二期修补颅骨缺损

目的 探讨颅骨瓣移植于髂骨外板保存，二期取出修补颅骨缺损的临床疗效。方法 颅脑损伤需去骨瓣减压患者去骨瓣后将骨瓣移植于髂骨外板骨膜下，术后定期X线测量．半年后取出骨瓣并测量，完成颅骨修补，同时对颅骨瓣移植于腹壁进行对比观察。结果 经测量移植于髂骨外板骨膜下的骨瓣吸收不明显，成功完成颅骨修补，术后骨瓣与颅骨愈合良好．而移植于腹部的骨瓣均有较为严重的骨吸收，体积缩小。结论 自体颅骨瓣移植于髂骨外板骨膜下能较长时间地保存颅骨瓣的活性，最大限度地降低骨质吸收，是自体颅骨瓣体内保存的理想方法。     

自体颅骨深低温保存再植的应用研究

目的 研究深低温保存的颅骨瓣自体回植后的临床效果.方法 颅脑创伤术后病人71例,高血压脑出血术后病人7例,腩肿瘤术后病人5例,脑动脉瘤术后病人3例,γ-刀术后去骨瓣减压病人3例.将手术取出的不带骨膜的游离骨瓣,经过处理后在深低温下保存,桦期行骨瓣回植.结果 所有病人均无排异反应和感染发生.79例顺利治愈,10例病人出现皮下积液,3例病人出现修补的颅骨凹陷.5例儿童病人术后骨愈合好,骨瓣与头颅同步增大,末出现颅骨发育异常.结论 深低温保存的自体颅骨瓣原位回植可以在最大程度上接近正常颅骨,保持颅骨的各种功能.     

自体粉碎颅骨骨块保存二期回植修补颅骨缺损(附12例分析)

目的探讨自体粉碎颅骨骨片修补颅骨缺损的方法及优缺点。方法回顾性分析2004年至2008年用保留的自体粉碎颅骨骨块行二期再植修补颅骨缺损12例患者的临床资料。结果 12例患者切口均一期愈合,术后外观满意,无感染,无积液。术后随访3～12个月,无骨瓣下陷、颅骨坏死及骨髓炎发生。结论用保留的自体粉碎颅骨骨块二期修补颅骨缺损效果良好。     

碘伏浸泡冷冻保存颅骨骨瓣308例报告

一、资料与方法 1．一般资料：作者于1999年开始对308例患者应用碘伏浸泡冷冻保存颅骨骨瓣。（1）自体颅骨保存方法：术中刮除颅骨外板的骨膜组织，庆大霉素盐水反复冲洗干净后置入无菌手套中，加入0．5％碘伏溶液，将骨瓣浸没，排除空气，扎紧密封，放入塑料盒中，标记患者姓名，性别，年龄，住院号，手术日期。放入冰箱-20℃冷冻保存；（2）自体颅骨成形时间：闭合性伤口手术后3—6个月，开放性伤口手术后6个月，伤口感染者1年以上。     

脑外伤后自体颅骨瓣修补颅骨缺损的时机选择

目前各项研究已经证实在颅脑外伤后应用自体颅骨进行颅骨缺损的修补效果较为肯定,但对自体颅骨行缺损修补的时机尚存争议.我科2000年至2011年以来随机选择在脑外伤后不同时间用自体颅骨瓣回纳修补颅骨缺损,以探讨颅骨缺损早期修补对患者预后的影响. 一、对象与方法 1.一般资料:本组153例均系颅脑外伤去骨瓣减压手术后患者,骨瓣均为额颞瓣,本次入院手术前均有不同程度神经功能障碍,排除既往有精神病史.     

颅骨固定钉在颅骨修补术中的应用

目的探讨颅骨固定钉在颅骨修补术中固定自体骨瓣的方法.方法自2002年2月至2003年6月对开颅减压术后骨瓣包埋皮下组织的患者行颅骨修补术,采用颅骨固定钉固定颅骨骨瓣,观察术中,术后检查情况.结果在二期手术中利用颅骨固定钉固定自体骨瓣固定牢固,平整,术后头颅X线拍片及CT检查示还纳的颅骨骨瓣无移位.结论应用颅骨固定钉固定还纳的自体骨瓣操作简便快速,固定牢固可靠,具有较好的安全性和疗效.     

粉碎颅骨瓣腹壁下保存及再植的临床应用

目的探讨粉碎颅骨瓣腹壁下保存及再植的临床应用价值。方法将12例去骨瓣减压开颅术患者的粉碎性颅骨瓣用丝线或医用胶整复固定腹壁下保存,然后择期取出作缺损颅骨修补。结果腹壁下保存3个月后所有骨瓣骨膜颜色鲜红、明显增厚,粉碎骨折片有不同程度的纤维愈合,骨瓣保持完整,骨瓣总体无明显吸收变小。将骨瓣复位后骨瓣与骨窗吻合良好,术后3~6个月X线检查移植骨瓣愈合良好。结论粉碎颅骨瓣腹壁下保存及再植修补颅骨缺损是可行的。     

3D打印PEEK材料治疗儿童颅骨缺损的临床应用

目的分析3D打印聚醚醚酮（PEEK）在儿童颅骨修补术中的应用效果。 方法选取新疆医科大学第一附属医院小儿神经外科自2019年1月至2021年3月收治的15例颅骨缺损或颅骨肿瘤患儿（PEEK组）,术前完善头颅CT薄层扫描,使用3D打印技术制备PEEK植入物,对患儿行颅骨修补术。选取同期行钛网颅骨修补的21例患儿进行对照（钛网组）,对比2组患儿的年龄、性别、原发病因、颅骨缺损部位及面积,分析患儿的术中情况及术后并发症发生情况。 结果所有患儿术后切口愈合良好,1例患儿术后出现皮下积液,经穿刺抽吸并加压包扎后积液消失,1例术区少量出血,经保守治疗后好转,其余患儿无明显术后并发症。PEEK组与钛网组患儿的手术时间、术中出血量、距上次手术时间及术后并发症发生率比较,差异均无统计学意义（P>0.05）。 结论使用3D打印PEEK植入物治疗儿童颅骨缺损是可行且安全的。     

早期颅骨修补对颅脑创伤患者预后的影响

目的 分析颅脑创伤后去骨瓣减压术后早期颅骨修补对患者长期功能预后的影响.方法 采用回顾性病例对照研究的方法比较颅脑创伤去骨瓣减压术后行早期的颅骨修补术(＜2个月)患者与术后行常规颅骨修补术(＞3个月)患者长期预后的差异,从而评价早期颅骨修补对于颅脑创伤行去骨瓣减压术患者的预后影响.早期颅骨修补组与延期颅骨修补组各23例,病例根据性别、年龄、颅脑创伤的严重程度及修补术前预后水平1:1配对.结果 比较外伤后15个月患者的预后水平,早期颅骨修补组(GOS:4.3±0.9;KPS:73.9±22.5)较延期颅骨修补组(GOS:3.8±1.0;KPS:62.6±24.2)有显著提高.结论 在掌握适应证的情况下去骨瓣减压后早期行颅骨修补术对患者预后的改善安全有效.     

优先颅骨修补后行脑积水分流术治疗创伤性脑积水合并颅骨缺损的疗效分析

目的探讨创伤性脑积水（PTH）合并颅骨缺损患者优先行颅骨修补而后行脑积水分流术的可行性,以及其对降低患者术后并发症、改善预后的临床意义。 方法选取济宁医学院附属医院邹城院区神经外科自2012年1月至2017年10月收治的32例PTH合并颅骨缺损患者为研究对象,均先以三维塑形钛网进行颅骨修补术,其中存在骨窗区明显脑膨出的患者,颅骨修补术中采取直接脑室穿刺释放脑脊液的方法促使膨出脑组织复位以利于钛网覆盖固定。颅骨修补术后1~3周根据脑积水临床症状变化将符合分流指征的患者择期再行脑脊液分流术。观察患者术后总体并发症发生情况及术后6个月GOS预后情况。 结果32例患者优先行颅骨修补术全部得以顺利实施,颅骨修补术后无明显相关并发症发生,其中28例再次接受脑积水分流术,4例因颅骨修补术后脑积水症状持续缓解未再接受分流术。术后脑积水症状较术前明显改善,有效率为94%;分期手术总并发症发生率为6.25%。术后6个月随访,本组患者中预后良好24例,中残4例,重残3例,死亡1例。 结论对于所有PTH合并颅骨缺损的患者,优先进行颅骨修补而后根据病情择期再行脑积水分流术的分期手术方案是切实可行的,且术后并发症发生率更低,对改善患者预后有重要临床意义。     

儿童去骨瓣减压术后早期颅骨成形术的疗效分析

目的 探讨儿童去骨瓣减压术后早期（3~6个月）颅骨成形术的效果。方法 回顾性分析2016年10月~2020年12月去骨瓣减压术后早期颅骨成形术治疗的16例儿童颅骨缺损的临床资料。结果 年龄2~13岁，平均6.4岁；1例血管畸形，15例为颅脑损伤；采用钛网10例，聚醚醚酮6例。术后随访8~48个月，平均25.06个月，切口均一期愈合；1例颅脑损伤术后钛网成形患儿，因摔倒致头颅再次外伤，使钛网变形、凹陷；其余15例患儿颅骨塑形满意，未出现头颅畸形，无切口感染、材料外露、皮下积液。结论 儿童去骨瓣减压术后早期颅骨成形术，可以有效保护儿童颅脑再次受损，同时有助于儿童心理及生理的康复。     

Sinking bone flap due to overdrainage of a ventriculoperitoneal shunt. A case report and review of the literature

The widespread use of decompressive craniectomy and subsequent cranioplasty has led to a better understanding of its complications. However, cases of a sunken bone flap have hardly ever been described. We present the eighth case reported up to date and perform a review of the literature of this sporadic complication.A 40-year-old Caucasian male suffered a traumatic brain injury that required a decompressive craniectomy. One month after initial trauma autologous cranioplasty was performed. A ventriculoperitoneal shunt was also placed. Neurological status progressively improved but his therapist noted cognitive status decline 8 months later. Follow-up computed tomography showed a progressive sinking bone flap. The patient underwent bone flap removal and a custom-made calcium phosphate-based implant was inserted, leading to symptoms resolution.Bone resorption has been described as the main cause of sinking bone flap following cranioplasty. This entity may manifest with symptoms of overdrainage in patients with cerebrospinal fluid shunt devices.     

Early combined cranioplasty and programmable shunt in patients with skull bone defects and CSF-circulation disorders

OBJECTIVE: This study assesses the clinical outcome after early combined cranioplasty (own frozen bone) and shunt implantation (Codman-Medos programmable VP shunt) in patients with skull bone defects and cerebrospinal fluid (CSF) circulation disorders.METHOD: Medical records were reviewed retrospectively for the last 100 patients with CSF disorders after trauma or subarachnoid hemorrhage (SAH), who previously underwent decompressive craniotomy owing to therapy-resistant brain swelling. Patients treated with early (5 to 7 weeks after injury) combined cranioplasty and shunt implantation were analysed and a follow-up for the survivors was obtained.RESULTS: In 60 patients with a daily CSF external drainage over 150 ml and dilated ventricles in CT scan, a programmable VP shunt was implanted simultaneously with the cranioplasty within 5.1 weeks after decompression. The neurological condition 6 months later was good (independent patients) in 39 cases (65%); 12 patients (20%) survived with a severe disability; three patients (5%) remained in a persistent vegetative state and only six patients (10%) died. There were few complications: bone or shunt infection (three cases), post-operative intracranial bleeding (one case), transitory neurological impairment after bone reimplantation (two cases), bone resorption (two cases) and shunt dysfunction (three cases).CONCLUSION: The early reimplantation of the patient's own skull bone combined to the employment of a programmable shunt system allowed us a dynamic adjustment of the intracranial pressure (ICP) changes. The combined treatment reduced the number of required surgical procedures, complications and unsatisfactory patient outcomes.     

颅骨修补术后皮瓣坏死与钛网外露原因分析及防治

目的 探讨颅骨修补术后皮瓣坏死与钛网外露的原因及防治措施。方法 回顾性分析11例颅骨缺损修补术后皮瓣坏死、钛网外露患者的临床资料,7例保留钛网,分别采取换药、减张后直接缝合、咬除外露钛网后缝合及转移皮瓣等措施修复;4例取出钛网后坏死皮瓣清创缝合。结果 11例患者坏死处皮瓣均愈合。7例保留钛网修复皮瓣的病例随访 2~24个月,未再发生皮瓣坏死、钛网外露。4例取出钛网病例中,2例1年后再行数字化成形钛网修补,2例放弃再修补手术。结论 颅骨缺损修补术后皮瓣坏死、钛网外露通过合理治疗可以保留钛网修复皮瓣,但对排异引起或发生化脓性感染病例,应及时取出钛网。     

Early vs late cranioplasty: what is better?

Aim of the study: Cranioplasty is the surgical repair of skull defects, which commonly is performed after traumatic skull injuries due to tumor removal or decompressive craniectomy. Several studies reported improvement in cognitive functions following cranioplasty in patients with severe brain damage. The reasons why exist such clinical improvement is not completely understood, although the increase in cerebrospinal fluid hydrodynamics with the potential improvement of local and global cerebral hemodynamics, blood flow, and metabolism may play a pivotal role. We investigated whether the cranioplasty improved neurological recovery and the whole array of cognitive functions or just some specific domains. Materials and methods: A total of 30 consecutive brain-injured subjects with craniectomy were enrolled and underwent a structured neuropsychological assessment immediately before the cranioplasty, 1 month after the cranioplasty and 1 year after the surgical procedure. Results: Our results showed that cranioplasty may facilitate the cognitive recovery, independently from the surgical timing. Particularly, we observed an important cognitive recovery in the period immediately after cranioplasty, while the improvement trend settles after a lapse of time, and the recovery starts to slow down. Conclusions: Cranioplasty seems to significantly improve neuropsychological and motor status in the patients with skull defects, independently from cranioplasty timing and patient's clinical status.     

深低温冷藏自体颅骨再植的临床研究

目的：探讨颅骨成形不同材料及方法的优缺点及此法的临床处理方法,方法：临床资料回顾性分析并结合献进行讨论。结果：56例深低温冷藏自体颅骨再植均无并发症,随访部分达骨性愈合,均无骨吸收现象。结论：此法优于其它修补材料及方法。     

CT perfusion imaging in the syndrome of the sinking skin flap before and after cranioplasty

The syndrome of the sinking skin flap (SSSF) has been described as one of the causes of neurological deficits after decompressive craniectomy We report a case of a 57-year-old woman with SSSF. Two years earlier, this patient, with no neurological deficits, underwent removal of the bone flap during treatment of an epidural abscess due to wound infection after a clipping operation for a ruptured aneurysm. The patient, who subsequently developed a sinking skin flap, gradually presented with gait disturbance and poor activity around 1 year before she came to our facility. On admission, neurological examination showed left hemiparesis and mild confusion. Cranioplasty with titanium mesh plate was performed. The cerebral blood flow (CBF) value in CT perfusion imaging in the symptomatic hemisphere increased from 23 to 31 cm3/100 g/min, and the value in the contralateral side increased from 37 to 41 cm3/100 g/min after cranioplasty. CT perfusion imaging after cranioplasty revealed the improvement of cerebral blood flow not only on the symptomatic side but also on the contralateral side. The patient recovered well and was discharged without hemiparesis and confusion 2 weeks after cranioplasty. As far as we know, this is the first reported case of SSSF examined with CT perfusion imaging before and after cranioplasty.