深低温贮存回植自体颅骨瓣的临床研究

Clinical Research on Autologus Skull Flap Replantation after being Preserved at Profound Hypothermia

目的:进行深低温贮存回植自体颅骨瓣的临床应用效果研究。方法:将74例患者术后骨瓣深低温(零下80℃)贮存,2~12月后予以原位回植,术中取骨标本病检,随诊1~36月。结果:74例中72例伤口Ⅰ期愈合,颅骨复位良好。病检示回植骨有正常骨细胞,与新鲜颅骨对照无骨母细胞。2例患者回植骨吸收明显,失去支撑作用而再次行修补钛网,2例感染,余下70例患者2~4月后骨缝不同程度增宽1~2 mm,6月后骨缝不再增宽,12~36月后骨缝部分变窄,达骨性愈合,而颅骨钻孔处及颞下骨缝较宽区未见骨性结构,为纤维疤痕愈合。结论:深低温贮存的自体颅骨部分骨细胞能长时间存活,回植后无免疫排异性。回植手术简便,患者容易接受,临床应用效果较好。

Objective： To practice clinical application effect research on autolugus skull flap replantation after being preserved at profound hypothermia. Methods： Skull flap of 74 patients was preserved at profound hypothermia （-80℃） after craniotomy and then rereplanted in situ after 2-12 months while skull tissue pathological examination was taken during operation. All cases was followed up for 1-36 months. Results： The operation incisions of 72 cases from total 74 cases were healed by stage Ⅰ , replanted skull repositioned well. Pathological examination revealed nor- mal bone cells survival in the replanted bone while no osteoblast found contrast with the fresh skull. Replanted bone was found absorbed obviously and lost the function of support so that the Ti net neoplasty had to be carried in 2 patients, another 2 received infection after operation, the suture of the others were broadened for some degree of 1-2 mm after 2-4 months. The suture＇s broadening stopped after 6 months and began to narrow after 12-36 months and arrived bony healing finally while fibrous scar but not bony construction was found in the drilling area and the infe^temporal area where suture was spacious. Conclusion： Part of the autologue skull tissue cells preserved at profound hypothermia can survive for a long time without any immunological rejection after replanting. The replantation is simple and easily be accepted by patients themselves, moreover excellent clinical application effect can be achieved.