钛网修补颅骨缺损276例经验

目的分析使用钛网进行颅骨修补术后的效果和出现的特殊问题,提高手术质量。方法 276例颅骨损伤病人,其中男性212例,女性64例;年龄16~84岁,平均年龄46.3岁。手工塑型:按照骨窗大小选择稍大的二维或三维钛网,根据术者颅骨外型在通用模具中进行手工塑型备用。数字化三维钛网预成型:术前行全头颅螺旋CT连续薄层扫描,并行颅骨三维成像,刻光盘由"钛网数字化成型机"对二维钛网进行成型加工后备用。手术按颅骨修补常规操作进行,将预成型并已经消毒的钛网按标记覆盖在骨窗上,周边选择适当的位置用配套的自攻钛钉固定牢靠。钛网中央选点用1号线悬吊8~10针。术后常规抗生素治疗,7~9d拆线。结果大多数病人术后切口愈合良好。早期钛网手工塑型,成形效果差异较大,个别病人有翘边现象。2006年10月起使用数字化钛网预成型,成型效果明显提高。颅骨修补后发生不良反应:皮瓣下积液12例,经观察全部可以自行吸收。术区积血或相临脑组织发生迟发性血肿6例,有2例再次开颅清除血肿,取出钛网。硬膜下与蛛网膜间形成积液囊8例,经保守治疗均有不同程度吸收。翼颞窝形成增生性包块2例,经特定电磁波照射后有所吸收变小变软。钛网发生后期排异反应4例,其中3例已取出钛网,1例自动出院。结论选择恰当的时机手术,材料的大小与形状匹配,解剖结构还原,使用钛网修补颅骨可以获得满意效果。

Application of titanium mesh in the repair of skull defects

Objective To analyze the peculiar problems in the cranioplasty with titanium mesh, for the purpose of improving its curative effect. Methods A total of 276 patients with skull defect were enrolled, which included 212 males and 64 females with age 16 - 84 years old （mean age 46.3 years old）. Largish two-dimensional or three-dimensional（3D） titanium mesh was chosen based on the bone window size and the plastotype was hand-made in the universal mold in accordance with the skull feature. Based on the 3D image of the whole skull continuous spiral CT thin slice scanning, the 3D titanium mesh was formed with digitalized titanium mesh molding. Routine cranioplasty was performed by covering the 3D titanium mesh on the skull window and fixed it with titanium nails and suture. The patients were treated routinely with antibiotics post operation and stitched after 7 - 9 days. Results Most of the patients healed normally, but warping phenomenon appeared in several individuals using hand-made mold in the earlier times. However, the results were obviously improved after the application of digitalized 3D formation. Some adverse reactions occured, which included 12 cases of hydrops under skin flap that were self-absorbed gradually, 6 cases of hematoeele or delayed hematoma（2 of them were treated by craniotomy and the titanium mesh was removed）, 8 cases of hydrops between subdural and arachnoid membrane that were absorbed after conservative treatment, 2 cases of proliferative temporal fossa mass that got smaller and softer after TDP treatment, and 4 cases of late rejection against titanium mesh（3 withdrawn and 1 self-discharged）. Conclusion It was demonstrated that the satisfactory result achieves in cranioplasty by choosing the correct operation opportunity, matching material （size and shape） and anatomical structure reduction.