硅胶和钛网用于颅骨成形失败的原因

Reasons for failure of silica gel and titanium mesh in cranioplasty

背景:颅骨成形术历史久远,但植入材料的选择一直无定论,虽不断更新,但始终不尽人意。目的:分析硅胶和钛网用于颅骨成形失败的原因。方法:选择5例有长期完整随访资料的颅骨成形患者,其中男2例,女3例,平均年龄53岁,共经历8次手术;取出硅胶3次,取出钛网3次,重新缝合切口而保留钛网2次;时间跨度最短2个月,最长20年;首发症状都是植入物外露或感染,植入材料以硅胶为主,另一种以切口哆开为特征,以钛网居多。所有病例手术前后均经CT扫描,结合临床症状对认为不取出植入材料不可能治愈的患者手术取出植入材料,并对清创取出的组织进行病理分析。结果与结论:(1)取出植入材料硅胶和钛网各3例,除了排异反应,偶发毛囊炎和外力撞击也是颅骨成形失败的促发因素;发病潜伏期为2个月-20年,主要表现为手术区域的感染和植入材料的暴露;(2)CT影像表现为炎症的病例,在病理上除了常见的白细胞浸润,还有整合素-X亚基(CD11c)和骨形态发生蛋白在炎性组织中表达;(3)结果表明,长达数月、数年甚至数十年的持续排异反应是硅胶和钛网植入失败的根本原因,偶发头皮毛囊炎和外力撞击是促发因素,病理切片上新发现的成骨反应还有待进一步考证。

BACKGROUND: Cranioplasty has a long history, but the choice of implant materials has been inconclusive, although constantly updated, ideal implant materials remain unavailable.OBJECTIVE: To analyze the reasons for the failure of silica gel and titanium mesh for cranioplasty.METHODS: Five patients with complete long-term follow-up data were selected, including two males and three females, with an average age of 53 years. After cranioplasty, a total of eight operations were performed, including three times of silica gel removal, three times of titanium mesh removal, twice of incision resuture and retaining titanium mesh. The shortest interval duration from cranioplasty was 2 months, and the longest was 20 years. The first symptom was implant exposure or infection. The implant material was mainly silica gel, and the other was incision doubling, and most were titanium mesh. All cases were scanned by CT before and after operation. Combined with clinical symptoms, patients who were considered impossible to be cured without removal of implant materials were surgically removed, and tissues removed by debridement were analyzed by pathology. RESULTS AND CONCLUSION:(1) Three cases of silicone and titanium mesh implants were removed respectively, besides rejection reaction, incidental folliculitis and external force impact were also contributing factors to the failure of cranioplasty;the latency period of onset was 2 months to 20 years, mainly manifested as infection in the surgical area and exposure of implant materials.(2) In addition to the common leukocyte infiltration, integrin-X subunit(CD11 c) and bone morphogenetic protein were also expressed in inflammatory tissues in cases with inflammation on CT imaging.(3) The results show that the sustained rejection reaction lasting for months, years or even decades was the root cause of the failure of silicone and titanium mesh implantation. Occasional scalp folliculitis and external force impact were the triggers. The newly discovered osteogenic reaction on pathological sections remains to be further verified.