灭活自体颅骨回植钛铆钉固定的临床应用

Clinical applications of devitalized autogenous calvarial bone flaps fixed with titanium clamps (CranioFix) for cranioplasty

目的总结灭活自体颅骨回植以钛铆钉固定进行颅骨修补术的临床应用经验。方法2000年3月至2003年12月对21例急性颅脑损伤等去骨瓣减压或颅骨本身受肿瘤侵蚀的患者,行自体颅骨普通冰箱冰冻保存后煮沸消毒,早期回植或受肿瘤侵蚀的骨瓣灭活后一期回植,以钛铆钉固定,随访观察修复效果。结果所有病例伤口均一期愈合,无并发症发生,随访6个月至2年半,X射线片及CT显示回植骨瓣边缘吸收未超出钛铆钉固定范围,头颅外观及牢度良好,肿瘤无复发。结论灭活自体颅骨回植进行颅骨修补术,方法简单、实用,利用钛铆钉固定可有效防止因回植骨瓣边缘吸收而导致的牢度下降。

Objective To evaluate reimplantation of devitalized autogenous calvarial bone flaps and the fixation of titanium clamps (CranioFix) for cranioplasty. Methods From March 2000 to December 2003, 21 patients underwent ① delayed reimplantation of preserved autogenous bone flaps, which were removed during the initial operations for increased intracranial pressure and stored in a freezer and autoclaved before use, or ② immediate reimplantation of tumor invaded bone flaps that were devitalized by boiling. All of these flaps were fixed with titanium clamps (CranioFix). Resorption of the bone flaps was monitored by skull roentgenograms and computed tomography (CT). The clinical and aesthetic results were evaluated. Results During the follow-up period of 6 to 30 months, no complications were found. There was slight resorption of the bone flaps in all cases, but the edge of the bone flaps was within the range of the titanium clamps according to skull roentgenograms and CT. Clinical and aesthetic results were highly satisfactory. Conclusions It is simple and practical using devitalized autogenous calvarial bone flaps for cranioplasty. The firmness decreasing of the reimplanted bone flap due to resorption can be prevented greatly by titanium clamps (CranioFix).