75例颅骨缺损患者个性化颅骨修补术的临床疗效分析

The analysis of clinical effect of individualized cranioplasty with different materials for 75 skull defect patients

目的总结不同材料个性化颅骨成形术的临床疗效。方法回顾性分析75例颅骨缺损患者，采用头颅CT超薄扫描（层厚1．5mm），三维重建，模拟缺损颅骨补片，应用激光快速成形技术，根据不同部位和缺损的情况，选用了硅橡胶、骨水泥及钛钢材料制作缺损颅骨及颅骨补片模型，经患者认可后手术植入。结果75例中采用嵌入性修补材料（硅橡胶、骨水泥）40例、覆盖性修补材料（钛网）35例，补片与颅骨均完整适配，术中均未经修整，平均手术时间45rnin。83％（63例）患者认为基本或完全恢复了原有颅形。术后并发症有：头痛5例，3个月后均自行消失；术后出现积液12例，其中8例未经处理，于10天后吸收，3例经过1～4次的抽吸后吸收，1例额颞部骨水泥修补者，因感染取出修补材料，1年后改用钛网修补；松动及移位2例，均为颞部缺损采用丝线固定方法，其中1例1年后改用钛网修补，另1例于3个月后自行稳定。嵌入性修补材料与覆盖性修补材料之间并发症的发生概率比较，有显著性差异（P〈0．05）。结论根据颅骨缺损部位，选择修补材料，能够最大限度地恢复患者颅骨外形，缩短手术时间，并且减少并发症和手术风险。

Objective To summarize the clinical effect of individualized cranioplasty with different materials. Method The clinical data of 75 patients with skull defect were analyzed retrospectively. Ultrathin cranial CT and three-dimension reconstruction were done to delineate the shape and contour of cranial defect. The templet for repair was fabricated with methyl silicone rubber, bone cement or titanium mest according to the condition of the bone defect with laser rapid prototyping technique. With patient＇s consent, the individualized templet was implanted to repair the cranial defect. Results Methyl silicone rubber or bone cement were used for 40 of 75 patients to fill the defects, and in the other 35 patients titanium mesh was used to cover the defects with overlapping edges. The patches matched cranial defect perfectly without the necessity of revision. The average operation time was 45 minutes. Perfect or excellent cosmetic results was obtained in 63 of the 75 patients （84%）. Postoperative complications were as follows： 5 patients complained of headache, which disappeared in there months. Collection of fluid under the scalp was found in 12 patients, among them the fluid was absorbed 10 days after operation in 8 cases without any treatment, while in 3 patients it disappeared after suction for 1--4 times. In the remaining one patient, the bone cement tem- plet was removed due to infection, and a titanium mesh was implanted one year later. Loosening and displacement of the templet occurred in 2 patients, and silk sufures were used for fixation in both patients. In these two patients, the templet became stable 3 months later, and in the other titanium was used for repair one year later. The incidence of complications was signifieantly different between inlay and onlay methods of repair （P〈0. 05）. Conclusion Individualized templet for cranial hone defect can best restore patient＇s configuration and shorten the operation time Side-effects can be minimized when an appropriate material is selected based on the location of the cranial defect.