个性化颅骨成形术中植入材料类型与颅骨缺损面积的关系

Association between implant materials and cranial defect area in individual cranioplasty

目的:分析个性化颅骨成形术中,植入材料类型与颅骨缺损面积的关系。方法:选择解放军总医院第二附属医院神经外科2002-03/2005-01和河北省三河市医院神经外科2003-09/2005-04收治的资料齐全的计算机辅助设计颅骨成形术患者75例,分为嵌入性材料(骨水泥、硅橡胶)组40例,根据颅骨缺损面积又分为大面积(≥36cm2)组17例和小面积(<36cm2)组23例;覆盖性材料(钛网)组35例,大面积组14例和小面积组21例。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,制作缺损颅骨及颅骨补片模型,患者认可后,根据患者的病情应用硅橡胶、骨水泥、钛网作为植入材料,进行手术植入。术后1周观察并发症:头痛、积液、松动。结果:75例患者的补片与颅骨完整适配,塑形满意,术中无需修整,平均手术时间45min,83%(63/75)患者感到基本或完全恢复了原有容貌。手术并发症:嵌入性材料组头痛4例,积液10例,松动2例,共16例,其中大面积组13例,小面积组3例;覆盖性材料组头痛1例,积液2例,松动0例,共3例次,其中大面积组2例,小面积组1例。应用精确概率分析,两材料组之间手术并发症差异显著,两材料组颅骨缺损面积之间手术并发症差异显著,嵌入性材料大面积组与覆盖性材料大面积组之间手术并发症差异显著,嵌入性材料小面积组与覆盖性材料小面积组之间手术并发症无显著性差异。结论:个性化设计的颅骨修补材料,能够最大限度的恢复患者外形,缩短手术时间,大面积的颅骨缺损应用钛网修补,小面积的应用钛网和嵌入性材料修补。根据患者颅骨缺损面积,选择不同植入材料,可以提高手术疗效,减少术后并发症。

AIM： To analyze the relation between implant material and the area of cranial defect in individual cranioplasty. METHODS： Totally 75 cranioplasty patients were enrolled from Department of Neurosurgery, Second Affiliated Hospital, General Hospital of Chinese PLA from March 2002 to January 2005 and Department of Neurosurgery, Sanhe Hospital from September 2003 to April 2005. All patients were divided into impaction matedal （bone cement, methyl silicone rubber） group （n =40）, which were sub-divided into large area （≥36 cm^2） group （n =17） and small area （〈 36 cmz） group （n =23）, and coverage material （titanium-networks） group （n =35）, which were sub-divided into large area group （n =14） and small area group （n =21）. Superthin cranial CT （1.5 mm） and three-dimension reconstruction had been done to simulate the shape and contour of cranial defect. The templates of the skull and defect were made with laser rapid prototyping technique. After patient＇s consent, methyl silicone rubber, bone cement or titanium-networks were used in operation based on the condition of bone defect. Complications were determined 1 week after operation such as headache, fluidify and cinch. RESULTS： Patches matched cranial defect perfectly without mended in 75 patients. Moulding was satisfactory and no need to trim. Average time of operation was 45 minutes. 83% （63/75） patients obtained perfect or excellent cosmetic results. Postoperative complications were as follows. Among impaction material group, 4 patients complaint headache, 10 patients suffered fluidifled under scalp, and the patches were shifted in 2 patients; 13 patients in the large area group and 3 patients in the small area group. Among coverage material group, 3 postoperative complications came out, including 1 patient complaint headache, 2 suffered fluidified under scalp, and no patches were shifted; 2 patients in the large area group and 1 patient in the small area group. The postoperative complications were significantly different between coverage material group and impaction material group after precise probability analysis. The postoperative complications were significantly different between different defect areas of the two material groups. Significant differences were found between large area group with impaction material and large area group with coverage material, but no significant difference was found between the small area groups. CONCLUSION： The individual substitute for cranial bone can utmostly restore patient＇s feature and shorten operation time. Coverage material （titanium-networks） is fit to large defect; both coverage material and impaction material can be used in small defect. Operative curative effect can be elevated and operative complications can be decreased when different implant materials are selected according to defect area.