镍钛合金支架-脑膜建复合体重建额窦修补脑脊液鼻漏的实验研究

Reconstruction of frontal sinus and repair of cerebrospinal fluid leakage with complex of shape- memory alloy brace and artificial dura in dog models

目的探讨一种新型颅底重建材料一镍钛合金支架一脑膜建复合体在动物实验中的疗效和实用性。方法以7只健康成年家犬为实验动物，构建额窦缺损一脑脊液鼻漏模型（拟单纯建模2只，实验治疗5只）。制作镍钛合金支架一脑膜建复合体及其相应简易器械，对动物模型进行重建额窦修补脑脊液鼻漏操作。术后观察颅骨外形、切口愈合及脑脊液漏情况。术后3月行X片、CT三维重建、MRJ及组织病理学检查。结果成功构建了健康成年家犬额窦缺损一脑脊液鼻漏模型7只．其中单纯建模、未实施实验治疗的1只于术后5d死亡，成功实施重建额窦修补脑脊液鼻漏手术6只（包括1只补充实验治疗的单纯建模动物），均全部存活，切口愈合良好，无脑脊液漏，无组织膨出及神经功能缺失等并发症；影像学检查显示支架显影清晰，位置满意，无伪迹；组织病理学显示支架周围肉芽组织生长。结论镍钛合金支架一脑膜建复合体应用于家犬重建额窦修补脑脊液漏手术时使用方便、效果良好。

Objective To explore the therapeutic effect of a new material--complex of shape-memory alloy brace and artificial dura （nitinol brace and NormalGEN） on reconstruction of frontal sinus and repair of cerebrospinal fluid leakage on dog models of lateral media skull base defect. Methods Seven adult healthy dogs were induced into models of frontal sinus defect and cerebrospinal fluid leakage; complex of nitinol brace and NormalGEN assisted by its corresponding apparatus was employed to reconstruct the defect and repair the leakage. The cranial profile, wound healing and leakage after operation were observed. Three months after the operation, cranial projections of X-ray, three-dimensional reconstruction of CT and 1.5T MRI were detected, and the histopathalogical outcome was noted. Results Seven dog models of frontal sinus defect and cerebrospinal fluid leakage were successfully established; 6 received reconstruction of frontal sinus and repair of cerebrospinal fluid leakage and survived without any complications as continuous leakage of cerebrospinal fluid, local tissue eminence and neurological function defect; 1 dead 5 d after the operation. The imaging detection showed that the nitinol brace was clear with satisfactory position without shift and artifact. Histopathalogical outcome showed that granulation tissue, which substituted NormalGEN, grew around the brace with a great quantity of fibroblast. Conclusion The complex of nitinol brace and NormalGEN assisted by its corresponding apparatus is suitable for reconstructing frontal sinus and repairing cerebrospinal fluid leakage in dog models.