中国修复重建外科杂志

中国修复重建外科杂志

  1. 期刊首页
  2. 期刊简介
  3. 投稿指南
  4. 在线期刊
  5. 本刊动态
  6. 期刊订阅
  7. 联系我们

可吸收固定系统在开颅骨瓣复位固定手术中的初步应用

邓跃飞 , 郑眉光 , 吴锦铨

中山大学孙逸仙纪念医院神经外科（广州，510120）

出版日期: 2016-08-31

PRELIMINARY APPLICATION OF ABSORBABLE FIXATION SYSTEM ON CRANIAL BONE FLAP REPOSITION AND FIXATION AFTER CRANIOTOMY

DENG Yuefei , ZHENG Meiguang , WU Jinquan.

Department of Neurosurgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou Guangdong, 510120, P.R.China. Corresponding author: DENG Yuefei, E-mail: fly040@sohu.com

查看全文

目的 观察可吸收固定系统对开颅游离骨瓣复位的固定效果及不良反应。 方法2010年7月－2011年12月，对67例开颅游离骨瓣成型切除颅内病变后患者，采用可吸收固定系统进行骨瓣复位固定。其中男38例，女29例；年龄5个月～73岁，中位年龄32岁。病程3个月～6年，中位病程25个月。幕上病变41例，幕下病变26例；其中位于额颞部13例，额顶部12例，颞顶部8例，颞枕部5例，顶枕部4例，后颅窝25例。诊断为胶质瘤15例，脑血管性疾病（动脉瘤、动静脉畸形及海绵状血管瘤）8例，脑膜瘤和蛛网膜囊肿各7例，听神经瘤和原发三叉神经痛各5例，胆脂瘤和脑脓肿各3例，垂体瘤、颅咽管瘤、转移瘤及放射性脑病各2例，髓母细胞瘤、室管膜瘤、生殖细胞瘤、非典型畸胎瘤/横纹肌样瘤、面肌痉挛及硬膜下血肿各1例。颅内病变范围3 cm × 2 cm～7 cm × 5 cm。观察术后局部切口及全身情况变化。 结果术后有2例幕上和3例幕下病变患者少许皮下积液，均经穿刺抽吸2周后消失；术后切口均Ⅰ期愈合，无红肿、发热等表现；术后2周内复查CT或MRI示骨瓣复位良好，内、外颅骨面均平整，无任何影像伪影。67例均获随访，随访时间3～20个月，平均10.3个月。切口无不适，头颅外观正常，无局部凹陷、积液等。CT或MRI复查未见骨瓣移位凹陷及伪影。 结论应用可吸收固定系统进行骨瓣复位固定简便、安全、可靠，且能消除术后CT或MRI复查时金属固定材料导致的伪影，近期疗效较好。

Objective To investigate the effectiveness and adverse effect of the absorbable fixation system on cranial bone flap reposition and fixation after craniotomy. Methods Between July 2010 and December 2011, 67 cases underwent cranial bone flap reposition and fixation with absorbable fixation system after craniotomy and resection of intracranial lesions. There were 38 males and 29 females with a median age of 32 years (range, 5 months to 73 years). The disease duration ranged from 3 months to 6 years (median, 25 months). Forty-one lesions were located at supratentorial and 26 at subtentorial, including at the frontotemporal site in 13 cases, at the frontoparietal site in 12 cases, at the temporal oprietal site in 8 cases, at the temporooccipital site in 5 cases, at the occipitoparietal site in 4 cases, and at the posterior cranial fossa in 25 cases. The diagnosis results were glioma in 15 cases, cerebral vascular diseases (aneurysm, arteriovenous malformation, and cavemous angioma) in 8 cases, meningioma in 7 cases, arachnoid cyst in 7 cases, acoustic neurinoma in 5 cases, cholesteatoma in 3 cases, primary trigeminal neuralgia in 5 cases, cerebral abscess in 3 cases, hypophysoma in 2 cases, craniopharyngioma in 2 cases, metastatic tumor in 2 cases, radiation encephalopathy in 2 cases, medulloblastoma in 1 case, ependymocytoma in 1 case, germinoma in 1 case, atypical teratoma/rhabdoid tumor in 1 case, facial spasm in 1 case, and subdural hematoma in 1 case. Intracranial lesion size ranged from 3 cm × 2 cm to 7 cm × 5 cm. The changes of local incision and general condition were observed. Results Subcutaneous effusion occurred in 2 supratentorial lesions and 3 subtentorial lesions, which was cured at 2 weeks after puncture and aspiration. All incisions healed primarily and no redness or swelling occurred. CT scans showed good reposition of the cranial bone flap and smooth inner and outer surfaces of the skull at 2 weeks after operation. All 67 patients were followed up 3-20 months (mean, 10.3 months). During follow-up, the skull had satisfactory appearance without discomfort, local depression, or effusion. Moreover, regular CT and MRI scans showed no subside, or displacement of the cranial bone flap or artifacts. Conclusion Absorbable fixation system for reposition and fixation of the cranial bone flap not only is simple, safe, and reliable, but also can eliminate the postoperative CT or MRI artifact caused by metals fixation system.

关键词: 颅骨; 开颅游离骨瓣成型; 内固定; 可吸收固定系统

Key words: Skull Free bone flap angioplasty after craniotomy; Internal fixation; Absorbable fixation system

引用本文： 邓跃飞,郑眉光,吴锦铨. 可吸收固定系统在开颅骨瓣复位固定手术中的初步应用. 中国修复重建外科杂志, 2012, 26(10): 1202-1205. doi: 复制

登录后 ，请手动点击刷新查看全文内容。 没有账号，
1. 邓跃飞, 赵义营, 张锦祥, 等. 经小脑延髓裂入路显微手术治疗儿童第四脑室肿瘤. 中华小儿外科杂志, 2012, 33(1): 9-12.
2. 鲁祥和, 郑伟明, 吴近森, 等. 枕下骨瓣开颅术治疗后颅窝病变. 中华神经外科杂志, 2006, 22(10): 609-611.
3. 祁磊, 王茂德. 颅骨骨瓣内固定技术应用现况及进展. 中华神经医学杂志, 2010, 9(3): 322-324.
4. 陈政刚, 周建, 杨堃, 等. 骨瓣复位成形术与咬骨窗术在后颅窝手术中的病例对照研究. 现代预防医学, 2011, 38(9): 1786-1789.
5. 杨树旭, 王义荣, 苏志鹏. 回复固定颅骨骨折骨瓣模型的比较研究. 中华创伤杂志, 2004, 20(4): 246-247.
6. 赵卫忠, 朱明霞, 高觉, 等. 颅骨固定钉在颅骨修补术中的应用. 中华神经医学杂志, 2005, 4(3): 290-291.
7. Winston KR, Wang MC. Cranial bone fixation: review of the literature and description of a new procedure. J Neurosurg, 2003, 99(3): 484-488.
8. Broaddus WC, Holloway KL, Winters CJ, et al. Titanium miniplates or stainless steel wire for cranial fixation: a prospective randomized comparison. J Neurosurg, 2002, 96(2): 244-247.
9. Yang YM, Chen XM, Ding F, et al. Biocompatibility evaluation of silk fibroin with peripheral nerve tissues and ceils in vitro. Biomaterials, 2007, 28(9): 1643-1652.
10. Hollander DA, von Waiter M, Wirtz T, et al. Structural, mechanical and in vitro characterization of individually structured Ti-6Al-4V produced by direct laser forming. Biomaterials, 2006, 27(7): 955-963.
11. Gordon PN, Komegay JN, Lattimer JC, et al. Use of a rivet-like titanium clamp closure system to replace an external frontal bone flap after transfrontal craniotomy in a dog. J Am Vet Med Assoe, 2005, 226(5): 752-754．.
12. Kovács AF, Sauer SN, Stefenelli U, et al. Growth of the orbit after frontoorbital advancement using nonrigid suture vs rigid plate fixation technique. J Pediatr Surg, 2008, 43(11): 2075-2081.
13. Brasileiro BF, Grempel RG, Ambrosano GM, et al. An in vitro evaluation of rigid internal fixation techniques for sagittal split ramus osteotomies: advancement surgery. J Oral Maxillofac Surg, 2009, 67(4): 809-817.
14. Uckan S, Bayram B, Keeik D, et al. Effect of titasnium plate fixation on mandibular growth in a rabbit model. J Oral Maxillofac Surg, 2009, 67(2): 318-222.
15. Lazennec JY, Madi A, Rousseau MA, et al. Evaluation of the 96/4PLDLLA polymer resorbable lumbar interbody cage in a long term animal model. Eur Spine J, 2006, 15(10): 1545-1553.
16. Shellock FG. Excessive temperature increases in pacemaker leads 3-TMR imaging with a transmit-receive head coil. Radiology, 2009, 251(3): 948-949.
17. Esen A, Ataoğlu H, Gemi L. Comparison of stability of titanium and absorbable plate and screw fixation for mandibular angle fractures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2008, 106(6): 806-811.
18. Dhol WS, Reyneke JP, Tompson B, et al. Comparison of titanium and resorbable copolymer fixation after Le Fort I maxillary impaction. Am J Orthod Dentofacial Orthop, 2008, 134(1): 67-73.