应用数字调控压模法技术构建颅骨修复体(英文)

Achieving cranium restoration by digit-controlled compression moulding technique

背景:钛板作为颅骨修复体因良好特性得到广泛应用。但颅骨形状复杂,修复体的现行制作技术成本高,设计和制造困难。目的:观察应用数字调控压模法制作适形颅骨修复体技术对神经外科颅骨缺损修复的效果。设计:回顾性观察。单位:解放军第三○三医院神经外科和解放军第一军医大学生物医学工程系。对象:选择2001-09/2004-09在解放军第三0三医院神经外科住院的外伤术后颅骨缺损患者20例,颅骨缺损部位:额颞部5例,颞顶部4例,颞额顶部4例,顶部4例,枕部3例。颅骨缺损范围:最小4cm×4cm,最大12cm×12cm。方法:应用原始颅骨CT数据三维重建,进行修复体的几何设计,完全拟合颅骨的自然形态。利用新型数控成型模制作系统,根据拟合修复体数据控制形成相应凹凸模型,将钛钢板压制成形,实现与创伤部分精确贴合。主要观察指标:颅骨修复术特点及术后恢复情况。结果:20例患者全部进入结果分析。①术后近期皮下积血2例,硬膜外血肿1例,脑内血肿1例,无脑挫伤发生。远期随访11例,全部缺口愈合良好,无发生感染、修复体松动、修复体外露等意外事故。②适形钛网颅骨修复术塑型精确、边缘贴合误差小,手术时间缩短,术后并发症明显减少,患者对修复外形及舒适的满意度达到100%。结论:应用数字调控压模法制作适形钛网人工颅骨修复术效果良好,各项指标优于传统的手工塑型颅骨修复术。

BACKGROUND： As cranium restoration substitute, titanium plate has been applied extensively for its better properties. Because of the complicated shape of cranium, it is costly and difficult to achieve cranium restoration at present. OBJECTIVE：To achieve properly shaped cranium restoration by using digit-controlled compression moulding technique in order to explore the value of it in neurosurgical restoration of cranium defects. DESIGN： Retrospective study. SETTING：Department of Neurosurgery, the 303 Hospital of Chinese PLA; Department of Biomedical Engineering, First Military Medical University of Chinese PLA. PARTICIPANTS： Twenty patients with post-traumatic cranium defects received treatment in the Department of Neurology, the 303 Hospital of Chinese PLA, between September 2001 and September 2004. Cranium defect： there were 5 cases in frontal-temporal cranium, 4 cases in temporal-parietal cranium, 4 cases in temporal-frontal-parietal cranium, 4 cases in parietal cranium, and 3 cases in occipital cranium. The scope of cranium defects ranged from 4 cm×4 cm to 12 cm×12 cm. METHODS：The primary cranium CT data were used to achieve threedimensional reconstruction and geometric design in order to completely imitate the natural shape of cranium. The novel digit-controlled compression moulding technique was applied to compress titanium board into the corresponding shape based on the restoration data adjusted to the real cranium. MAIN OUTCOME MEASURES： Characteristics of cranium restorationand postoperative recovery. RESULTS： Data of the 20 cases entered the final statistical analysis. ①Postoperative short-term hypodermic hematocele occurred in 2 cases, epidural hematoma in 1 case, and intracerebral hematoma in 1 case： no brain contusion occurred. From the long-term follow-up on 11 cases, all presented better outcomes, and no inflammation, prosthesis loosening or exposure occurred. ②The properly, shaped titanium cranioplasty has multiple advantages such as precise moulding, minor error in matching with border, shortened operation time and fewer postoperative complications. Patients felt comfortable and all of them were satisfied with the contour. CONCLUSION： Properly-shaped titanium substitute made by digit-controlled compression moulding technique was used in cranium restoration and proved to have better outcomes, with each parameter superior to the traditional manual cranioplasty.