可吸收固定系统在开颅骨瓣复位固定手术中的初步应用

PRELIMINARY APPLICATION OF ABSORBABLE FIXATION SYSTEM ON CRANIAL BONE FLAP REPOSITION AND FIXATION AFTER CRANIOTOMY

目的观察可吸收固定系统对开颅游离骨瓣复位的固定效果及不良反应。方法 2010年7月-2011年12月,对67例开颅游离骨瓣成型切除颅内病变后患者,采用可吸收固定系统进行骨瓣复位固定。其中男38例,女29例;年龄5个月～73岁,中位年龄32岁。病程3个月～6年,中位病程25个月。幕上病变41例,幕下病变26例;其中位于额颞部13例,额顶部12例,颞顶部8例,颞枕部5例,顶枕部4例,后颅窝25例。诊断为胶质瘤15例,脑血管性疾病(动脉瘤、动静脉畸形及海绵状血管瘤)8例,脑膜瘤和蛛网膜囊肿各7例,听神经瘤和原发三叉神经痛各5例,胆脂瘤和脑脓肿各3例,垂体瘤、颅咽管瘤、转移瘤及放射性脑病各2例,髓母细胞瘤、室管膜瘤、生殖细胞瘤、非典型畸胎瘤/横纹肌样瘤、面肌痉挛及硬膜下血肿各1例。颅内病变范围3 cm×2 cm～7 cm×5 cm。观察术后局部切口及全身情况变化。结果术后有2例幕上和3例幕下病变患者少许皮下积液,均经穿刺抽吸2周后消失;术后切口均Ⅰ期愈合,无红肿、发热等表现;术后2周内复查CT或MRI示骨瓣复位良好,内、外颅骨面均平整,无任何影像伪影。67例均获随访,随访时间3～20个月,平均10.3个月。切口无不适,头颅外观正常,无局部凹陷、积液等。CT或MRI复查未见骨瓣移位凹陷及伪影。结论应用可吸收固定系统进行骨瓣复位固定简便、安全、可靠,且能消除术后CT或MRI复查时金属固定材料导致的伪影,近期疗效较好。

Objective To investigate the effectiveness and adverse effect of the absorbable fixation system on cranial bone flap reposition and fixation after craniotomy. Methods Between July 2010 and December 2011, 67 cases underwent cranial bone flap reposition and fixation with absorbable fixation system after craniotomy and resection of intracranial lesions. There were 38 males and 29 females with a median age of 32 years （range, 5 months to 73 years）. The disease duration ranged from 3 months to 6 years （median, 25 months）. Forty-one lesions were located at supratentorial and 26 at subtentorial, including at the frontotemporal site in 13 cases, at the frontoparietal site in 12 cases, at the temporal oprietal site in 8 cases, at the temporooccipital site in 5 cases, at the occipitoparietal site in 4 cases, and at the posterior cranial fossa in 25 cases. The diagnosis results were glioma in 15 cases, cerebral vascular diseases （aneurysm, arteriovenous malformation, and cavemous angioma） in 8 cases, meningioma in 7 cases, arachnoid cyst in 7 cases, acoustic neurinoma in 5 cases, cholesteatoma in 3 cases, primary trigeminal neuralgia in 5 cases, cerebral abscess in 3 cases, hypophysoma in 2 cases, craniopharyngioma in 2 cases, metastatic tumor in 2 cases, radiation encephalopathy in 2 cases, medulloblastoma in 1 case, ependymocytoma in 1 case, germinoma in 1 case, atypical teratoma/rhabdoid tumor in 1 case, facial spasm in 1 case, and subdural hematoma in 1 case. Intracranial lesion size ranged from 3 cm × 2 cm to 7 cm × 5 cm. The changes of local incision and general condition were observed. Results Subcutaneous effusion occurred in 2 supratentorial lesions and 3 subtentorial lesions, which was cured at 2 weeks after puncture and aspiration. All incisions healed primarily and no redness or swelling occurred. CT scans showed good reposition of the cranial bone flap and smooth inner and outer surfaces of the skull at 2 weeks after operation. All 67 patients were followed up 3-20 months （mean, 10.3 months）. During follow-up, the skull had satisfactory appearance without discomfort, local depression, or effusion. Moreover, regular CT and MRI scans showed no subside, or displacement of the cranial bone flap or artifacts. Conclusion Absorbable fixation system for reposition and fixation of the cranial bone flap not only is simple, safe, and reliable, but also can eliminate the postoperative CT or MRI artifact caused by metals fixation system.