带骨膜自体颅骨骨瓣腹部皮下包埋保存修补颅骨缺损100例

背景：颅骨缺损多数由于重型颅脑损伤或自发性脑出血需要行去骨瓣减压术，一般在首次手术后3~9个月行颅骨缺损成形术，自体颅骨作为一种最理想的修补材料已渐引起神经外科医生的关注。 目的：用自体带骨膜颅骨瓣经腹膜下埋藏保存3~9个月后取出作缺损颅骨修补，观察骨瓣的大小、形状、骨膜的变化。 方法：重型颅脑损伤、脑出血严重、脑疝形成，清除血肿后颅内压仍高，需作去骨瓣减压者100例。开颅术锯开骨瓣时，保留完整骨膜。在左中上腹切开，暴露浅筋膜，将骨瓣凸面紧贴皮下脂肪，缝合切口。在3~9个月后，取出带骨膜的自体颅骨骨瓣。于保存前后测量带骨膜的骨瓣的长度、宽度、厚度、对角线的长度。 结果与结论：经过6年100例临床测量、观察对比，保存三四个月72例，骨瓣边缘锐利，无吸收，骨瓣无变小，骨膜色鲜红、稍显增厚、软；保存9个月1例，骨瓣边缘圆顿，明显吸收，骨瓣变小明显，骨膜色淡、骨性增生明显、硬；其余介于两者之间。结果表明，带骨膜的自体颅骨骨瓣在腹壁皮下保存，能较长时间保持颅骨大小、形状、活性。

Subperitoneal embedding of autologous cranial valve with periosteum for repair of cranial defects in 100 cases

BACKGROUND: Cranial defects need decompressive craniectomy owing to severe craniocerebral injury or spontaneous cerebral hemorrhage. Cranioplasty is generally necessary at 3-9 months after first surgery. Autologous cranial bone, as an ideal repair material, has aroused wide attention from neurosurgeons. OBJECTIVE: After 3-9 months of subperitoneal embedding, autologous cranial valves with periosteum were taken out for repair of cranial bone defects. Cranial valves were observed in terms of size and shape as well as periosteal changes. METHODS: In totally 100 severe cranial injury patients presenting with severe cerebral hemorrhage, brain herniation and high intracranial pressure after hematoma removal needed decompressive craniectomy and were included in this study. Craniotomy was performed with intact periosteum left. The mid/upper left quadrant abdominal skin was dissected to expose the superficial fascia. The convex surface of cranial valve was made close to the subcutaneous fat, followed by incision suture. Autologous cranial valves with periosteum were taken out after 3-9 months. Prior to and after preservation, the length, width, thickness, and diagonal length of cranial valves with periosteum were measured. RESULTS AND CONCLUSION: 6-year clinical observation revealed that 72 cases of cranial valves were preserved for 3-4 months, showing sharp valve edge, without absorption or shrank cranial valve, bright red, soft, slightly thickened periosteum; 1 case of cranial valve was preserved for 9 months, showing blunt valve edge, obvious absorption, markedly reduced valve, light-colored periosteum, obvious osseous hyperplasia; the cranial valves of other cases showed phenomena between these two. These findings demonstrate that subperitoneal preservation of autologous cranial valve with periosteum can maintain the size, shape, and activity of cranial bone.