数字化预制钛网成形修补额颞顶巨大颅骨缺损(附20例报告)

Repair of large frontal temporal parietal skull defect with digitally reconstructed titanium mesh: a report of 20 cases

目的探讨数字化预制钛网成形修补额颞顶巨大颅骨缺损的临床效果和手术技巧。方法空军总医院2006年11月-2012年5月收治的巨大额颞顶颅骨缺损患者20例,男13例,女7例,年龄18～58岁,平均39岁,缺损大小7.0cm×9.0cm～11.5cm×14.0cm,平均8.5cm×12.0cm。患者均行头颅CT螺旋扫描,进行全颅骨数字化三维成像,根据对称性原理描绘出缺损颅骨的形态和几何尺寸,输入数字化精密车床预制出边缘略大于(1.0～1.5cm)缺损尺寸的钛网,剪边后得到最后的修复体。于去骨瓣术后6个月～1年行颅骨修补手术。结果本组20例患者应用数字化钛网修补额颞顶巨大颅骨缺损,钛网与缺损边缘颅骨严密贴合,塑形效果好,操作简单,手术时间明显缩短,术后外形美观、对称,无并发症发生。结论数字化钛网修补额颞顶巨大颅骨缺损明显优于传统术中手工塑形修补术,可提高患者生活质量,值得临床推广。

Objective To explore the clinical effect and surgical technique of the repair of large defect involving frontal,temporal,and parietal regions using digitally reconstructed titanium mesh.Methods Twenty patients with large frontal,temporal,and parietal skull defect hospitalized in Air Force General Hospital from November 2006 to May 2012 were involved in this study.In these 20 patients,there were 13 males and 7 females,aged 18-58 years（mean 39 years）,and the defect size measured from 7.0cm×9.0cm to 11.5cm×14.0cm（mean 8.5cm×12.0cm）.Spiral CT head scan and digital three-dimensional reconstruction of skull were performed in all the patients.The shape and geometric size of skull defect was traced based on the symmetry principle,and then the data were transferred into digital precision lathe to reconstruct a titanium mesh slightly larger（1.0-1.5cm） than the skull defect,and the finally the prosthesis was perfected after pruning the border.Cranioplasty was performed 6-12 months after craniotomy using the digitally reconstructed titanium mesh.Results The digitally reconstructed titanium mesh was used in 20 patients with large frontal,temporal,parietal skull defect.The surgical technique was relatively simple,and the surgical duration was shorter than before.The titanium mesh fit to the defect of skull accurately with satisfactory molding effect,good appearance and symmetrical in shape.No related complication was found in all the patients.Conclusion Repair of large frontal,temporal,parietal skull defect with digitally reconstructed titanium mesh is more advantageous than traditional manual reconstruction,and it can improve the life quality of patients.