神经补片在颅脑损伤硬脑膜减张修补中的应用

在神经外科手术中，修补缺损的硬脑膜对于维持解剖学的完整和保护脑组织，防止脑脊液漏、颅内感染、脑膨出、癫痫等并发症是十分必要的。目前．在国内主要是应用自体膜及人工硬脑膜材料来修补缺损的硬脑膜。硬脑膜修补取材多样，各有优缺点。本院对2004年9月至2008年3月对颅脑损伤行去骨瓣减压术的208例病人，应用Neuro—Patch神经补片修复硬脑膜122例，与86例开颅自体组织修复硬脑膜分组进行比较．取得了一定的疗效。报告如下。     

生物型人工硬脑膜在重型颅脑损伤术中的应用

目的 探讨生物型人工硬脑膜在重型颅脑损伤术中的应用价值.方法回顾性分析92例重型颅脑损伤患者因外伤导致硬脑膜缺损或开颅去骨瓣减压术需硬脑膜减张缝合而采用生物型人工硬脑膜进行硬脑膜修补,对其术后相关并发症及其随访结果进行分析.结果全部病例手术切口愈合良好,无颅内感染、脑脊液漏的发生.随访无迟发性排异反应发生,4例分离颞肌与硬脑膜黏连时不慎将新生硬脑膜分破,未发现硬脑膜与皮层相黏连.结论生物型人工硬脑膜在重型颅脑损伤术中的应用是安全、有效的.     

分期手术治疗头皮慢性溃疡伴颅骨坏死一例

脑膜瘤为起源于软脑膜蛛网膜细胞的良性肿瘤,约占颅内肿瘤的13%～17%,是中枢神经系统除胶质瘤外最常见的肿瘤[1]。手术时需要切除病变的硬脑膜,为了保持硬脑膜层的完整往往需要使用人工补片修补硬脑膜。 而人工材料一旦感染,往往导致切口迁延不愈,处理较为困难。我院近期采用高渗盐水持续湿敷使材料脱落,分期手术治愈1例脑膜瘤切除术后头皮大面积慢性溃疡伴颅骨坏死患者,报道如下。     

整形美容外科相关的生物材料

生物材料是用于取代、修复活组织的天然或人造材料.按其来源可分为天然生物材料和人工生物材料,后者又进一步分为聚合物、金属和无机非金属生物材料.根据这种分类,笔者将对目前临床上常用的生物材料作以简单介绍.     

二论加速我国医用生物材料的研究与开发──关于医用生物材料(植入体)的安全性评价与评价标准

4　医用生物材料 (植入体 )与生物体间的相互作用及材料的生物化问题4.1　医用生物材料及其分类　4.1.1　医用生物材料又称生物医学材料、生物材料或医用材料 ,整形外科又称人工组织代用品。医用材料是一类具有特殊性能、特种功能的 ,用于人工器官再造、外科修复、理疗康复、诊     

人工合成皮的进展

近几年来,对人工合成皮的研究工作再度受到重视,而且取得了相当的成效。目前合成的人工皮,就材料来分,可概括为三类:高分子材料、生物材料、高分子和生物材料的聚合物。临床上将人工皮分为暂时性和半永久性人工皮。随着体外上皮细胞培养及高分子生物材料的进展,即将出现一种永久性人工皮。高分子材料     

疝修补材料感染的机制预防和处理

应用生物材料行无张力疝修补术已日益受到广大医患人员的欢迎,并逐渐在全国得以推广。然而,随着生物材料在疝修补术中的使用增加,与生物材料有关的感染也时有发生,而且感染后在处理上也非常棘手,往往会导致修补失败。因此，作为手术者有必要了解生物材料相关感染的机理及预防和治疗。生物材料相关感染机理１.感染发生的基本过程感染的第一环节是手术室空气中、手术人员身体上和手套破损后的细菌进入伤口。感染材料的细菌主要为表皮葡萄球菌,其次为铜绿假单孢菌族、链球菌及奇异变形杆菌等。细菌进入伤口后经过一系列变化,定居在失活组织和生…     

二论加速我国医用生物材料的研究与开发--关于医用生物材料(植入体)的安全性评价与评价标准

4 医用生物材料(植入体)与生物体间的相互作用及材料的生物化问题 4.1 医用生物材料及其分类 4.1.1 医用生物材料又称生物医学材料、生物材料或医用材料,整形外科又称人工组织代用品.医用材料是一类具有特殊性能、特种功能的,用于人工器官再造、外科修复、理疗康复、诊断、治疗疾患等医疗及保健领域,而对人体组织、血液不致产生不良影响的材料.其主要研究的内容包括:①具有特种功能和性能的共性和个性的研究,即全面的理化性能的研究;②生物体生理环境、组织结构、器官生理功能及其替代方法的研究;③材料与生物体相互作用的研究;④材料的灭菌、消毒、安全性评价标准和方法以及管理等方面的研究.     

丝素膜代人工硬脑膜的组织相容性研究

目的　探讨丝素膜为人硬脑膜修补材料的可能性。方法　取新西兰兔额顶部正中切口 ,作双侧颞顶部开颅术 ,在手术显微镜下 ,剪除兔硬脑膜和蛛网膜 1.0cm× 0 .8cm ,硬脑膜缺损处分别用牛心包和不同的丝素膜膜修补。结果　术后无伤口感染、脑膜炎及抽搐现象 ,行为及进食无异常变化。早期 ,局部炎症反应轻微。晚期 ,呈轻度慢性炎性反应 ,致密丝素膜与脑皮层之间可见薄层假膜形成。脑皮质形态正常。结论　对制作工艺加以改进 ,丝素膜有望成为一种新型的脑膜替代材料。     

手术治疗粉碎性前颅底骨折的探讨

目的 探讨粉碎性前颅底骨折重建与修补的方法、疗效.方法 50例粉碎性前颅底骨折患者行颅底重建手术,采用带蒂帽状腱膜骨膜瓣或人工硬膜修补硬膜,自身骨片重建粉碎的前颅底.结果术后随访 1个月至半年,脑脊液漏5例,颅内感染 2例,死亡 1例.脑脊液漏及感染者经治疗均痊愈.结论 采用带蒂帽状腱膜骨膜瓣或人工硬脑膜修复粉碎性前颅底骨折并行骨性重建效果良好,强调严密修补硬膜.     

Duraplasty: our current experience

BACKGROUND: A large variety of biologic and artificial materials have been suggested as dural substitutes. However, no ideal material for dural repair in neurosurgical procedures has been identified. The authors report their experience with Tutoplast processed dura and pericardium. METHODS: This study is designed to evaluate Tutoplast dura and pericardium. The study population was composed of 250 consecutive patients who underwent cerebral duraplasty with these homologous materials between 1996 and 1998. The average follow-up was 5.4 years. RESULTS: We have observed only four complications with uncertain relationship with the dural implant. These resulted in complete recovery. CONCLUSIONS: We support the efficacy and safety of this natural dural substitute treated with Tutoplast method.     

CO(2) Laser Fascia to Dura Soldering for Pig Dural Defect Reconstruction.

Background and objectives: The purposes of this study were to demonstrate that laser soldering is safe and effective for tissue bonding in dural reconstruction and to compare this new reconstruction technique to an established one. Study design: A temperature-controlled fiberoptic CO(2) laser system or fibrin glue were used for in vitro dural defect reconstruction in two groups of pigs. The CO(2) laser technique was also used for dural reconstruction in live pigs. Results: The burst pressure of the reconstructed dura by the laser system was significantly higher than that of fibrin glue (mean pressure 258.5 +/- 117.3 cm H(2)O and 76.8 +/- 47.2 cm H(2)O, respectively). There were no postoperative complications and no signs of thermal damage to the dura, fascia, or underlying tissue on histological analysis following the in vivo CO(2) laser experiments. Conclusions: Temperature-controlled laser soldering is an effective technique for dural repair. It creates a strong tissue bonding with no thermal damage to the tissue. The burst pressure of the reconstructed dura done with laser soldering is significantly higher than that of fibrin glue.     

A New Absorbable Synthetic Substitute With Biomimetic Design for Dural Tissue Repair

Dural repair products are evolving from animal tissue–derived materials to synthetic materials as well as from inert to absorbable features; most of them lack functional and structural characteristics compared with the natural dura mater. In the present study, we evaluated the properties and tissue repair performance of a new dural repair product with biomimetic design. The biomimetic patch exhibits unique three‐dimensional nonwoven microfiber structure with good mechanical strength and biocompatibility. The animal study showed that the biomimetic patch and commercially synthetic material group presented new subdural regeneration at 90 days, with low level inflammatory response and minimal to no adhesion formation detected at each stage. In the biological material group, no new subdural regeneration was observed and severe adhesion between the implant and the cortex occurred at each stage. In clinical case study, there was no cerebrospinal fluid leakage, and all the postoperation observations were normal. The biomimetic structure and proper rate of degradation of the new absorbable dura substitute can guide the meaningful reconstruction of the dura mater, which may provide a novel approach for dural defect repair.     

Repair of spinal dural defects. An experimental study

The search for an ideal substance for duraplasty has stimulated clinical and experimental investigations. To date a large number of materials have been employed for dural repair, although there is as yet no unanimity regarding the ideal material. Most of these studies have been concerned with cranial dura, and spinal duraplasty has received less attention. This study was designed to examine the repair of spinal dural defects in the dog. The materials chosen for this experiment were autologous fat, a polyester fiber mesh (Mersilene) and silicone-coated Dacron (Dura Film). Nineteen dogs were used in this study. Following lumbar laminectomy and the excision of elliptical pieces of dura (1.0 X 0.5 cm) at three noncontiguous levels, each of the defects was repaired using one of the three materials. Groups of animals were sacrificed at each of 3, 6, 12, and 24 weeks after dural repair. The lumbar region was removed en bloc and prepared for histological examination. Repair of the dural opening was achieved in all cases. The polyester fiber mesh was quite effective for dural repair, serving as a scaffold through which a neomembrane grew and united the dural edges. The results with autologous fat were similarly favorable. On the other hand, results with silicone-coated Dacron showed encapsulation by connective tissue, with the ventral aspect of the graft frequently compressing the underlying cord.     

Biologically inert synthetic dural substitutes. Appraisal of a medical-grade aliphatic polyurethane and a polysiloxane-carbonate block copolymer

Two types of artificial membranes, a medical-grade aliphatic polyurethane and a polysiloxane-carbonate block copolymer, were tested as substitutes for dura in 24 and 12 rabbits, respectively. The films were placed either epidurally, subdurally, or as dural grafts in equal subgroups of animals. The postoperative course was uneventful with no manifestations of convulsive disorder or cerebrospinal fluid leak. The animals were sacrificed 3, 6, or 9 months after implantation of the artificial membranes. Both types of artificial membranes were easily removed from the underlying nervous and the other surrounding tissues. The histological examination failed to reveal adhesions, neomembrane formations, or any type of foreign body reactions to the polyurethane film. The implantation of the polysiloxane-carbonate film caused no reaction when it was applied epidurally. As a dural graft, the polysiloxane-carbonate copolymer induced the formation of a thin neomembrane of one to two layers of fibroblasts which formed a watertight seal of the dural defect. A similar thin neomembrane was found to encase this artificial membrane in the group of animals in which it was implanted subdurally. There was no foreign body reaction to the polysiloxane-carbonate film. The authors conclude that these materials hold promise as dural substitutes or in the prevention of spinal dural scarring, and should be evaluated clinically.     

Dural cyst at the foramen magnum

A 69-year-old male presented with a rare dural cyst manifesting as numbness and pain in the limbs. Magnetic resonance imaging revealed a mass anterior to the medulla oblongata appearing as low intensity on T(1)-weighted and high intensity on T(2)-weighted imaging, with no enhancement. A cystic lesion ventral to the medulla oblongata was removed via the lateral suboccipital transcondylar approach. Histological examination showed the wall of the cyst consisted of fibrous connective tissue with a dense zone and a loose zone, similar to the structure found in the dura mater. The lesion was diagnosed as dural cyst. Dural cysts can be defined as cyst with the wall consisting of dura mater-like fibrous tissue, and attached to the dura mater. The origin of the present dural cyst was considered to be congenital.     

Comparative dural closure techniques: a safety study in rats

BACKGROUND: Some neurosurgical procedures have high morbidity and mortality rates due to cerebrospinal fluid (CSF) fistula development, particularly when dural defects are in relatively inaccessible areas or surrounded by friable dura. We used a rat model to test 4 different dural closure techniques to determine which one was significantly superior for achieving a watertight dural closure with minimal harm to brain tissue. METHODS: The rats were randomly divided into 2 groups. The first group (group A, n = 40) was used to test the strength of the adhesivity for CSF leakage. Histopathologic studies were used to evaluate the granulation tissue between the dura and dural graft. Effects on the brain tissue were studied in the second group (group B, n = 40) where lipid peroxidation was determined. These 2 groups consisted of 5 subgroups: control, methyl metacrylate, n-butyl cyanoacrylate, fibrin glue, and CO(2) laser. RESULTS: Methyl metacrylate and CO(2) laser techniques were inadequate for stopping dural leakage and had harmful effects on brain tissue. Cerebrospinal fluid leak was observed only in 1 rat in the n-butyl cyanoacrylate subgroup and this result was statistically significant (P = .0005), but lipid peroxidation levels for this material showed that it was not safe for dural closure in case it leaked through the dural defect. The lipid peroxidation levels of the fibrin glue subgroup were not statistically significantly different from the control group (P = .440). CONCLUSIONS: Fibrin glue was the safest material with a CSF leakage risk that was higher than n-butyl cyanoacrylate (25% vs 12.5%) but acceptable. This study showed no relationship between the CSF leak and histopathologic findings for sealant properties of the tissue adhesives.     

防止椎板切除术后硬脊膜外瘢痕粘连的实验研究

作者在４个平面间隔切除１１只山羊的椎板，分别用硅胶膜、自体游离脂肪片、带蒂肌肉瓣覆盖硬脊膜，一处平面作空白对照。术后４个月组织学检查，结果显示，硅胶膜后方有少许瘢痕组织增生，间质中有炎细胞灶状浸润，硅胶膜与硬膜囊无瘢痕形成，新形成的椎管后壁光滑，硬膜囊无受压；脂肪片被纤维组织取代，周围纤维组织增生轻微，形成菲薄之纤维膜，与硬脊膜容易分离；带蒂肌肉瓣周围形成较多瘢痕与硬脊膜粘连重，肌肉瓣已完全纤维化，空白组形成瘢痕最多，与硬脊膜粘连最重。术后硬膜囊矢状径以硅胶膜组最大，脂肪片组次之，带蒂肌肉瓣组再次之，空白组最小。作者认为，硅胶膜与脂肪片能明显防止椎板切除术后纤维瘢痕粘连对硬膜囊的压迫，在支架诱导作用方面，硅胶膜优于脂肪片，在生物相容性方面脂肪片优于硅胶膜。带蒂肌肉瓣优于对照组，但不及前两者。     

Evaluation of dural closure techniques. Suture methods, fibrin adhesive sealant, and cyanoacrylate polymer

A study was undertaken to investigate the relative strengths of dural repair using standard suture techniques, suture supplemented with tissue adhesive, and tissue adhesive alone. The efficacy of two tissues adhesives, fibrin adhesive sealant and cyanoacrylate polymer, as adjunctive or the sole means of effecting dural closure, was studied. In vitro analysis of repair techniques was accomplished using fresh human cadaveric dura. Uniform 4 mm defects were created, repaired using various techniques, and then subjected to pressurization testing. Defects repaired with suture alone leaked at pressurization levels within the physiologic range, while those supplemented with tissue adhesives failed at higher pressurization levels. In vitro testing, accomplished in white New Zealand rabbits, supported this conclusion. Histologic sections obtained from dura treated with fibrin adhesive sealant demonstrated minimal inflammatory response, while those sections obtained at the site of dural repair augmented with cyanoacrylate polymer featured significant inflammatory responses, including dural thinning, gliosis, and cortical necrosis. Results indicate that a new substance, fibrin adhesive sealant, appears to have application as an adjunctive means of effecting dural closure.     

Clinical application of a new bioabsorbable artificial dura mater

OBJECT: In their pursuit of a better substitute for dura mater in neurosurgical procedures, the authors review their experience with GM972. METHODS: A newly developed synthetic dural substitute composed of bioabsorbable polymers (GM972) was placed in 53 patients during neurosurgical procedures. The handling properties of the material, surgical wound features. and findings of hematological, computerized tomography, and/or magnetic resonance imaging examinations were evaluated. The average follow-up period was 35.5 months. The handling properties and biocompatibility of this new dural substitute were highly satisfactory, and no significant complication was observed. In patients who underwent a second surgery performed more than 18 months after the initial operation, this new dural substitute was found to have been replaced by autologous collagenous tissue. Because of its bioabsorbability, chronic foreign body reactions to this synthetic dural substitute were negligible. CONCLUSIONS: In this report the authors support the effectiveness and safety of this bioabsorbable artificial dural substitute that provides a reduced risk of transmission of latent infection.