自体颅骨瓣皮下包埋后Ⅱ期回植58例临床分析

我科2006年10月～2012年10月间采用皮下埋藏的自体颅骨瓣结合钛网、钛连接片、颅骨锁回植行颅骨修补共58例,疗效满意,现报道如下。1资料和方法1.1一般资料:本组58例,男39例,女18例;年龄5～55岁,平均30岁;本组病例入院后6例行单纯     

带颞浅动脉蒂颅骨外板移植修复面部凹陷畸形

自１９９１年４月起我们应用带颞浅动脉蒂颅骨外板移植修复面部凹陷畸形７例获满意效果，此皮瓣具有接近受区骨质并近似面骨、术后骨质吸收少、供区隐蔽、术后疼痛轻等优点     

Cranioplasty with autogenous autoclaved calvarial bone flap in the cases of tumoural invasion

Summary When a bone flap is raised in the course of a craniotomy, the ideal is to replace it at the end of the procedure. When it is invaded by tumoural cells, it cannot be replaced due to the risk of tumoural recurrence. In these cases we have autoclaved the bone flap to be able to replace it with no fear of tumoural recurrence.Between October 1989 and October 1995 sixty-two patients required autoclaving of the bone flap in the course of a craniotomy due to tumoural invasion (thirty-five meningiomas, sixteen bone tumours, five metastases, and eight scalp tumours).The infiltrated bone flaps were removed, cleaned, autoclaved for 20 minutes at 134 °C and 1 kg/cm² and re-implanted.Patients were followed-up for 10 to 58 months (average 41 months). At every follow-up visit skull x-ray studies, clinical examination, and photographs were done. When needed a CT scan was performed to assess the thickness of the bone flap.On follow-up roentgenograms partial resorption was observed in twelve cases (19.3%). CT scan studies showed loss of thickness in another thirty-five cases (56.4%). Meanwhile the external aspect remained unchanged.In six cases (3.2%) biopsies of the bone flaps were taken at a second surgical procedure. They showed newly formed bone partly re-populated by osteocytes but retaining areas of sequestered bone.We conclude that autoclaved bone, if replaced with direct contact with living bone, it is gradually repopulated with osteocytes. Cranial vault autoclaved autologous bone flap is a good alternative when the original bone flap is invaded but not destroyed by tumoural cells.     

皮下保存自体骨瓣及早期颅骨成型术后的骨质生物学改变

骨瓣的生物化学指标可以达到正常颅骨的水平.     

Reconstruction of complex defects with composite calvarial flaps

Over the past four years, composite calvarial flaps have been used to reconstruct complex defects in 14 patients. In three of the patients they were free flaps for hand reconstruction. Clinical application (technical details) and complications are also discussed.     

带颞浅动脉蒂颅骨外板移植修复面部凹陷畸形

自1991年4月起我们应用带颞浅动脉蒂颅骨外板移植修复面部凹陷畸形7例获满意效果,此皮瓣具有接近受区骨质并近似面骨、术后骨质吸收少、供区隐蔽、术后疼痛轻等优点。     

Posterior-only approach with titanium mesh cages versus autogenous iliac bone graft for thoracic and lumbar spinal tuberculosis

Objective: This study aimed to compare the effectiveness of titanium mesh cages (TMCs) with autogenous iliac bone grafts (AIBG) in posterior-only surgery for thoracic and lumbar spinal tuberculosis.Design: Retrospective investigative design.Setting: The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.Participants: A total of 146 patients with thoracic or lumbar tuberculosis.Interventions: All patients underwent a posterior-only approach with either a TMC (86 cases) or AIBG (60 cases).Outcomes measures: Operation duration, intraoperative blood loss, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), visual analogue scale (VAS), and related complications were used to compare the effectiveness and feasibility of the two techniques. Frankel grading system, Cobb angle, and loss of angular correction were employed to assess neurological and kyphotic improvements.Results: There were significant improvements in ESR, CRP, VAS, Frankel grade, and Cobb angle at the last follow-up (P < 0.05) when compared with the preoperative state. The TMC group was superior in operation duration (P < 0.001), intraoperative blood loss (P = 0.007), VAS (P < 0.001), loss of angular correction (P < 0.001), and surgical complications as compared with the AIBG group. There were no significant differences in the improvement of the Frankel grade and Cobb angle between the TMC and AIBG groups (P > 0.05). A recurrence of tuberculosis was not found in either of the groups.Conclusion: Compared to autogenous iliac bone grafts, titanium mesh cages could serve as a superior material in posterior-only operative therapy for thoracic and lumbar spinal tuberculosis.     

自体颅骨移植在眶底重建中的应用

目的 评价自体颅骨移植在治疗面部外伤致眶底缺损中的作用。方法 对34例面部创伤眶底爆裂骨折（以下简称眶底骨折）有骨质缺损者,采用冠状切口取自休遭受,结膜切口加外眦切开入路进行骨移植修复缺损。结果 所有病例术后创口愈合良好,无感染。供骨区无并发症发生。1例术后3个月内有轻微下睑外翻,通过自行按摩半年后已不明显,8例术前有眶下区麻木者,术后1-6个月全部恢复,4例有复视者术后消失,通过半年至5年（平衡11个月）的随诊,移植骨成活良好,供受骨区切口瘢痕不明显,均取得了满意的临床疗效。结论 自体颅骨移植并发症少,对眶底的重建有许多优点。是眶底重建的理想移植材料。     

自体红骨髓注射治疗陈旧性腕舟状骨骨折

目的 探讨一种简单、安全、有效、微创的治疗陈旧性腕舟状骨骨折的方法。方法 采用自体红骨髓注射于骨折端的方法。结果 11例经3～12个月(平均8个月)随访，骨折均愈合，平均愈合时间为3个月。结论 本方法治疗陈旧性腕舟状骨骨折简单安全、微创、恢复快、临床疗效满意。     

塑型钛板颅骨修补20例临床应用

目的 探讨塑型钛板在颅骨修补术中的临床效果。方法 对我科在2009年4月~2010年10月收治各种原因引起的颅骨缺损20例,使用塑型钛板进行颅骨修补术的临床资料进行回顾性分析。结果 20例塑型颅骨修补术病人,手术时间除2例颅骨肿瘤为即时修补外,其余均为第一次手术后3～6个月;除1人术后出现继发癫痫外,其余均恢复良好。术后无伤口感染、皮下积液、继发出血、钛板外露等并发症,术后颅骨外观恢复满意。结论 采用塑型钛板行颅骨修补术,手术快捷方便、效果满意,具有广泛临床应用价值。     

自体微小颗粒骨复合肝细胞生长因子（HGF)修复骨缺损的实验研究

目的探讨自体微小颗粒骨复合肝细胞生长因子(hepatocyte growth factor,HGF)修复骨缺损的效果,以找到一种新的促进骨愈合的方法。方法将30只新西兰大耳白兔双侧桡骨中段制成骨缺损模型,分别植入自体微小颗粒骨、HGF和自体微小颗粒骨与HGF的复合物,同时设空白对照组,分别手术后第4、8周进行大体观察、X线检查及组织学检查,术后第8周进行压缩试验,比较修复骨缺损的疗效。结果经大体观察、组织学及X线检查发现,术后第8周自体微小颗粒骨复合HGF能更有效地修复节段性骨缺损,对照组无骨愈合迹象。结论自体微小颗粒骨复合HGF具有优良的修复骨缺损(包括因骨质疏松所致的骨皮质空洞)的能力,为骨缺损修复提供了一种新方法。