自体颅骨修补术治疗颅骨缺损

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150例患者去骨瓣减压获得的颅骨密封于双层无菌塑料袋,保存于-17℃冰箱。术后1～3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CT扫描观察骨瓣缘的吸收情况。结果147例患者达到一期愈合;2例患者因抓抠伤口骨瓣暴露发生感染,经换药引流无效,进行了二次手术取出骨瓣。20例出现皮下积液,均行穿刺加压包扎,伤口一期愈合。1例患者术后一年出现溶骨、骨瓣断裂现象,再次手术取出骨片,钛网修补。结论冷冻保存的自体颅骨可以安全、可靠地用于颅骨修补,外观上更接近解剖学特点,更能接近患者容貌,患者无心理障碍,且费用低廉,患者更易于接受,值得推广。     

普通冰箱低温保存自体颅骨回植应用于儿童颅骨缺损2例

目的 探讨普通冰箱低温保存自体颅骨回植应用于儿童颅骨回植应用于儿童颅骨缺损的临床效果。并与其他方法进行比较。方法 利用普通冰箱低温保存自体颅骨瓣。回植时经煮沸高压蒸气灭菌后，原位回植于颅骨缺损处。结果 2例颅骨缺损患经治疗，回植骨瓣顺利完成爬行替代过程，达到愈合。结论 该法应用于儿童颅骨缺损患是切实可行的，不受任何条件限制。可随时进行颅骨回植，克服了其他方法的局限性，并具有保存方法简单，无排斥反应，不影响儿童头颅发育等优点。     

深低温保存自体颅骨瓣移植的应用研究

颅脑损伤患者 ,去骨瓣减压术可造成颅骨缺损 ,我们在动物实验基础上 ,采用深低温保存技术冷冻保存自体颅骨瓣 ,待患者恢复后择期行骨瓣原位回植修补颅骨缺损 ,并对回植手术后患者的一般情况和骨瓣的转归进行随访检查。现报告如下。一、对象与方法1.临床资料 :本组 5 1例皆为颅脑损伤后行去颅骨瓣减压术患者 ,男性 32例 ,女性 19例 ,年龄 8～ 5 3岁 ,平均 18.3岁。取下的骨瓣最大 10cm× 8cm ,最小 6cm× 5cm ,其中 4例骨瓣破裂为两块 ,回植时用丝线固定。2 .颅骨瓣的保存 :当患者行开颅去骨瓣减压术时 ,将不带骨膜的游离骨瓣在尽可能短的时…     

自体颅骨深低温保存与再植49例分析

目的 探讨自体颅骨深低温保存再植于颅骨缺损的手术时机、方法.方法 回顾分析我院49例采用自体颅骨深低温保存进行修补的颅骨缺损患者的临床资料.结果 无1例死亡,无1例发生排斥反应,仅3例出现颅内感染、头皮下积液,发生率为6.12%.结论 把握手术时间窗,采用自体颅骨深低温保存行颅骨修补可减少并发症,获得良好预后.     

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.     

自体颅骨早期修补颅骨缺损35例

目的探讨体外保存的自体颅骨早期修补颅骨缺损的可行性、手术技巧及适应证。方法回顾分析35例采用体外环氧乙烷消毒保存的自体颅骨与钛颅骨锁早期修补颅骨缺损的临床资料。结果颅骨缺损后4—8周行自体颅骨修补,无手术死亡及感染,术后硬膜外积液、积血4例,硬膜下积液2例,并发症发生率17．14％（6／35）。结论采用环氧乙烷消毒保存自体颅骨,方法简便、安全、并发症少;自体颅骨结合钛颅骨锁早期修补颅骨缺损是可行的。     

保存自体颅骨骨瓣修补颅骨缺损的26例分析

修补颅骨缺损的材料很多，目前临床上主要用钛合金。我院从1995年2月至2002年11月，用保留自体颅骨骨瓣修补颅骨缺损26例，取得了很好的效果。     

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.     

自体颅骨修补颅骨缺损51例分析

目的 探讨颅骨缺损自体颅骨修补的手术时机、方法及术后并发症的防治。方法 回顾性分析我院51例采用自体颅骨与钛夹进行修补的颅骨缺损患者的临床资料。结果 无1例死亡，但有11例分别出现颅内感染、硬膜外积液、出血、癫痫等并发症，发生率21．6％（11／51）。结论 把握手术时间窗行自体颅骨和钛夹修补可减少并发症，获得较好预后。     

超低温保存自体粉碎颅骨成形骨瓣植入术

一、资料与方法1.一般资料:本组68例,男50例,女18例,年龄4-68岁,平均33.5岁。颅骨损伤的原因:交通事故伤48例,坠落伤9例,打击伤7例,跌伤4例,均为闭合性颅脑损伤。全组均经头颅CT扫描提示颅骨多发性骨折,凹陷性骨折及颅内血肿。粉碎程度2-6片不等。并发硬膜下血肿脑挫伤33例,脑疝18例。入院时意识状况(Glasgow计分示)Gcs 6-     

Cryostored autologous skull bone for cranioplasty? A study on cranial bone flaps’ viability and microbial contamination after deep-frozen storage at −80 °C

Craniectomy is a life-saving procedure. Subsequent cranioplasty with autologous skull bone has a bone resorption rate from 4% to 22.8% and an infection rate from 3.3% to 26%. There are concerns with their viability and the potential microbial contamination as they were explanted for a long period of time. Eighteen cranial bone flaps stored at Prince of Wales Hospital Skull Bone Bank during the period from June 2011 to March 2016 were identified. Ethics approval was obtained. Bone chips and deep bone swabs were collected for osteoblast culture and microbial culture. Skull Bone Bank was kept at −80 °C under strict aseptic technique during the study period. The storage period ranged from 4 months to 55 months. For the osteoblast culture, all eighteen bone flaps had no viable osteoblast growth. For the bacterial culture, five had positive bacteria growth (27.8%). Three were Pasteurella multocida and two were Methicillin-resistant Staphylococcus aureus. The mean duration of storage of the infected bone flap was 32.9 months (±15.1 months) versus 19.9 months (±17.9 months) of those bone flaps with no bacterial growth (p = 0.1716). The mean size of the infected versus non-infected bone flaps was 117.7 cm² (±44.96 cm²) versus 76.8 cm² (±50.24 cm²) respectively (p = 0.1318). Although in this study statistical significance was not reached, it was postulated that infected bone flaps tended to be larger in size and had a longer duration of storage. In conclusion, cryostored skull bone flaps beyond four months showed no viable osteoblasts. Bacterial contamination rate of bone flaps was 27.8% in this study.     

Complications following cranioplasty using autologous bone or polymethylmethacrylate—Retrospective experience from a single center

Objective

A decompressive hemicraniectomy is a potentially life-saving intervention following head trauma. Once performed patients are obliged to undergo a second procedure with cranioplasty. Two of the most commonly used materials are autologous bone and polymethylmethacrylate (PMMA). We have now evaluated complications following a cranioplasty using these materials.

Materials and methods

During a 7-year period (2002–2008) 49 patients were operated with a decompressive craniectomy following head trauma. Patients received a cranioplasty consisting of autologous bone (30 patients, 61.2%) or PMMA (19 patients, 38.8%) and were followed at least 24 months. Patient data were collected retrospectively.

Results

Twenty patients (20/49, 40.8%) experienced a complication that prompted a re-operation. There was a significantly higher rate of complications leading to a re-operation (53.3% vs. 21.1%, p = 0.03) and a shorter survival time of the cranioplasty (mean 48.1 ± 7.8 vs. 79.5 ± 9.0 months, p = 0.035) in patients with autologous bone compared to PMMA. Bone resorption and the presence of postoperative hematomas were significantly more common in patients with autologous bone. The material used for cranioplasty was the only variable that significantly correlated to the rate of complications.

Conclusions

In our series we had a high percentage of patients needing re-operation due to complications following a cranioplasty. Though generally considered a straightforward procedure, complications and associated morbidity in patients undergoing cranioplasty should not be underestimated.     

孤独症患儿脑单光子发射计算机体层摄影术的研究

目的 研究孤独症患儿的脑血流和细胞功能.方法 采用单光子发射计算机体层摄影术,对31例符合中国精神疾病分类方案与诊断标准第2版修订本中孤独症的诊断标准的患儿(研究组)和20名排除神经精神科疾病、患躯体疾病的非孤独症儿童(对照组)进行脑影像分析.结果 (1)视觉定性分析,研究组中有27例存在36个放射性分布减低区,其中以左侧额叶(13个)和双侧颞叶(左右侧分别为6个和8个)皮质较多见.(2)放射性计数分析,研究组左侧额叶(84±34)和海马(62±23)低于右侧[分别为(88±32)和(67±26)],差异有非常显著性(P<0.01);对照组各部位左右侧比较,差异均无显著性.结论 孤独症儿童左侧额叶、海马及双侧颞叶存在局部血流灌注降低和细胞功能障碍.     

长期应用抗癫癎药控制的颞叶癫癎患者发作间期SPECT异常灌注灶修复与长程视频脑电图变化的临床研究

目的：探讨抗癫癎药（AEDs）长期控制的颞叶癫癎患者发作期间应用单光子发射电子计算机断层扫描（SPECT）检查异常灌注灶的修复。方法：颞叶癫癎患者经AEDs、步长脑心通胶囊与尼莫地平治疗,并在两次发作间期行SPECT、长程视频脑电图（V-EEG）和CT/MRI检查。结果：44例癫癎患者平均年龄为25岁;平均病程为3.5年;44例患者中病因明确者为19例（家族史2例,围产期损伤1例,热性惊厥3例,颅脑损伤出血1例,颅脑外伤5例,脑膜脑炎3例,脑部手术2例,多病因2例）。癫癎发作控制平均为25个月。治疗前发作间期SPECT异常（颞叶和非颞叶）感兴趣区（ROI）为77.3%,长程V-EEG异常77.3%（其中癎样放电88.2%）,治疗前CT/MRI异常47.7%。治疗后发作间期SPECT正常增加4.5%（P〉0.05）,异常灶减少8.3%（P〉0.05）;长程V-EEG正常增加27.3%（P〈0.05）,癎样放电减少53.3%（P〈0.05）;结论：长期控制的颞叶癫癎患者的异常灌注灶修复明显低于其他类型癫癎,防治重点应放在颞叶癫癎症状出现之前的继发性全身强直阵挛发作。     

Patients with West syndrome whose ictal SPECT showed focal cortical hyperperfusion

To clarify the mechanism of clustered spasms in West syndrome (WS), we examined ictal SPECT and EEG, as well as those during the interictal period, in three patients with symptomatic WS who had apparent focal cerebral lesions. For ictal SPECT and EEG, we monitored the patients with EEG, and as soon as we noticed the occurrence of clustered spasms clinically and electroencephalographically, [(99m)Tc]ECD was injected intravenously and flushed thoroughly with saline. In these three patients, regional cerebral blood flow (rCBF) increased during ictus and decreased during the interictal period in the area that coincided with the focal cerebral lesion recognized by CT/MRI. The ictal hyperperfusion of bilateral basal ganglia was also detected in two of the three patients. The ictal EEG showed a diffuse slow wave complex corresponding to a clinical spasm. The sharp waves that preceded the diffuse slow wave complex and the spasm appeared in the same area in which rCBF increased during ictus. None of the patients showed partial seizure before or after clustered spasms clinically or electroencephalographically during the ictal SPECT study. Secondary generalization from a cerebral focus may explain the mechanism of spasms in these patients with WS: focal cortical discharge may primarily generate clustered spasms and trigger the brainstem and basal ganglia structures to produce spasms.     

Nigro-striatal degeneration demonstrated in parkinsonian patients with iodine-123-beta-CIT SPECT: Methods of quantitation

Single photon emission computed tomography (SPECT) images were obtained in 3 healthy volunteers and 7 parkinsonian patients 22 h after injection of 120 MBq iodine-123-beta-CIT. There was a high radioactivity in the striatal region against a uniform background in the volunteers but pronouncedly reduced striatal activity in the patients. Total striatal activity in each hemisphere of each individual was calculated as the sum of all activity in excess of the background in all reconstructed images. There was a high correlation between reduction of striatal activity and motor scores in the unified rating scale for parkinsonism (URSP) for the patients. A method developed for calculation of the activity distribution along the length axis of the striatum indicated a more pronounced degeneration in the putamen compared with the caudate nucleus in the patients. Iodine-123-beta-CIT SPECT appears to be a good quantitative method for nigro-striatal degeneration in parkinsonian patients.     

颞肌成形在颅骨成形术中的临床应用

目的探讨颞肌成形在颅骨成形术治疗颅骨缺损中应用的临床效果。方法回顾性分析2013年1月至2016年12月111例因颅骨缺损行颅骨成形术的临床资料,术中行颞肌的充分游离,并成形、固定。结果术后1个月行颞肌功能锻炼,术后随访3~6月;病人双侧颞部对称,皮肤切口愈合良好,无颞前区塌陷及颞肌下坠畸形,无明显颞肌萎缩,颞肌功能保留。结论颅骨成形术中进行颞肌成形,可以有效恢复颅骨缺损处颞部的外形和颞肌功能,进一步完善颅骨成形术的治疗效果。     

MRI and SPECT of Klinefelter's Syndrome with Various Neuropsychiatric Symptoms: A Case Report

Abstract: We present here magnetic resonance imaging (MRI) and single photon emission computed tomography with ¹²³I-N-isopropyl-p-iodoamphetamine (¹²³I-IMP-SPECT) of a patient suffering from Klinefelter's syndrome with various neuropsychiatric symptoms. He was a 30-year-old male, who showed impaired consciousness seizures, auditory hallucination, delusion of reference, delusion of grandeur, psychomotor excitement and intellectual impairment. Although no focal lesion was detected by computed tomography or T1-weighted MRI, T2-weighted MRI provided a heterogeneous high-signal-intensity lesion of the inferior part of the left temporal lobe, which was not enhanced with Gd-DTPA. In addition ¹²³-IMP-SPECT exhibited focal hypoperfusion in the left temporal lobe on the early images. We suggest that the neuropsychiatric symptoms of this case are associated with the focal organic brain dysfunction which was revealed by MRI and ^123I-IMP-SPECT.     

Atomoxetine administration combined with intensive speech therapy for post-stroke aphasia: evaluation by a novel SPECT method

Objectives: We clarified the safety, feasibility, and efficacy of atomoxetine administration combined with intensive speech therapy (ST) for patients with post-stroke aphasia. In addition, we investigated the effect of atomoxetine treatment on neural activity of surrounding lesioned brain areas. Materials and Methods: Four adult patients with motor-dominant aphasia and a history of left hemispheric stroke were studied. We have registered on the clinical trials database (ID: JMA-IIA00215). Daily atomoxetine administration of 40 mg was initiated two weeks before admission and raised to 80 mg 1 week before admission. During the subsequent 13-day hospitalization, administration of atomoxetine was raised to 120 mg and daily intensive ST (120 min/day, one-on-one training) was provided. Language function was assessed using the Japanese version of The Western Aphasia Battery (WAB) and the Token test two weeks prior to admission, on the day of admission, and at discharge. At two weeks prior to admission and at discharge, each patient's cortical blood flow was measured using ¹²³I-IMP-single photon emission computed tomography (SPECT). Results: This protocol was successfully completed by all patients without any adverse effects. Four patients showed improved language function with the median of the Token Test increasing from 141 to 149, and the repetition score of WAB increasing from 88 to 99. In addition, cortical blood flow surrounding lesioned brain areas was found to increase following intervention in all patients. Conclusions: Atomoxetine administration and intensive ST were safe and feasible for post-stroke aphasia, suggesting their potential usefulness in the treatment of this patient population.