自体颅骨修补创伤性颅骨缺损术后并发症的分析

Postoperative complications of cranioplasty using autologous bone for traumatic skull defect

目的分析应用自体颅骨修补创伤性颅骨缺损的术后并发症。方法回顾性分析2011年1月至2018年12月临沂市人民医院神经外科应用自体颅骨修补创伤性颅骨缺损患者的临床资料,共758例。观察患者的颅骨修补效果、术后的并发症及其发生时间。结果758例患者均成功完成颅骨修补术。术后因大面积脑梗死死亡1例(0.13%),术后第2天影像学复查发现迟发性硬膜外血肿1例(0.13%)。757例患者的随访时间为12~36个月(中位数为14个月)。随访期间发生手术部位感染并取出颅骨16例(2.11%),其中13例感染出现在术后8~72 d(中位数为21 d),另外3例分别出现在术后4、11及30个月;严重骨吸收7例(0.92%),颅骨吸收在术后4~6个月开始出现,严重骨吸收出现在术后12个月左右。结论应用自体颅骨修补创伤性颅骨缺损的严重并发症和手术失败率可控制在相对较低的水平,自体颅骨仍可作为颅骨修补的选择材料;自体颅骨使用中需防控术后感染,特别是早期感染的防控,并需对骨吸收的情况进行随访。

Objective To investigate the postoperative complications of cranioplasty using autologous bone for traumatic skull defect.Methods Between January 2011 and December 2018,a total of 758 consecutive patients with traumatic skull defect underwent cranioplasty using autologous bone at Department of Neurosurgery,Linyi People′s Hospital.Their clinical data were retrospectively analyzed in this study.The outcomes of cranioplasty,postoperative complications and their occurrence time were documented.Results All 758 patients underwent cranioplasty successfully.One patient(0.13%)died of massive cerebral infarction.One patient(0.13%)developed delayed epidural hematoma on the second day post operation.The follow-up duration of 757 patients were 12-36 months with a median of 14 months.During the follow-up period,16 cases(2.11%)reported infection in the surgical site resulting in removal of bone flap,among which infection occurred at 8-72 days post operation(median:21 days)in 13 cases,and the remaining 3 cases reported infection at 4,11 and 30 months post operation respectively.Seven cases(0.92%)had severe bone resorption.Bone resorption began to appear at 4-6 months after operation,and severe bone resorption occurred about 1 year after operation.Conclusions The rates of severe complications and surgical failures can be controlled at relatively low levels in cranioplasty using autologous bone for traumatic skull defect,so autologous skull bone is still a suitable choice for cranioplasty.It is necessary to pay attention to the prevention and control of postoperative infection,especially early infection,and bone resorption needs to be followed up.