High Scalp Tension after Three-Dimensional Titanium Mesh Repair for Skull Defect: 2 Case Reports

Rationale: The three-dimensional (3D) computer-made titanium mesh is widely used in the skull repair for those patients receiving decompression of the bone flap. It can restore normal anatomy to a greater extent and make a better appearance. Case Presentation: We reported two cases of patients admitted to our hospital who have experienced high scalp tension after skull repair. At first, these two patients underwent decompression of the bone flap, and the physical examination results showed a defect of skull. No neurological symptoms and signs were found. The 3D computed tomography (CT) reconstruction of skull was performed, and then the skull repair with 3D titanium mesh was conducted. But because of high scalp tension, they underwent a second operation, during which we re-trimmed and reduce the arc of the titanium mesh. The scalp incision of both patients healed well and no titanium mesh was exposed. Both patients have a good prognosis. Lessons: We highlight that the high tension of scalp due to overstretching after 3D titanium mesh repair for skull defect should be paid much attention to. Trimming and reducing the arc of titanium mesh is an effective treatment for this situation.

Repair of infectious scalp defects with titanium mesh exposure by scalp rotation flap

Objective To explore the application of scalp rotation flap in reconstruction of infectious scalp defect with titanium mesh exposure. Methods Twelve patients were treated in this group including 4 males and 8 female. S The defective size ranged from 2. 0 cm × 5. 0 cm to 0.

Surgical Resection of Sternal Tumors and Reconstruction with Titanium Mesh

Objective To evaluate the use of titanium mesh reconstruction after sternal tumor resection. Methods From January 2007 to January 2011, 14 patients with sternal tumors were admitted into Peking Union Medical Hospital. The clinical characteristics, surgical resection, and technique of reconstruction were reviewed. Results Of the 14 patients, 3 had a metastatic sternal tumor, the primary sites of which were as follows: hepatic carcinoma in one case (metastasis 19 years after operation), breast carcinoma in another case (metastasis 5 years after operation), and renal carcinoma in the other case (found simultaneously). Two patients showed local involvement of the sternum: 1 had thymic carcinoma, and the other had myofibrosarcoma. The remaining 9 patients had primary tumors: 4 were osteochondroma, 3 chondrosarcoma, 1 eosinophilic granuloma, 1 non-Hodgekin's lymphoma. En bloc resection of the sternal tumor was performed in all the 14 patients. The defect was repaired with the titanium mesh adjusted to the shape of the defect and fixed with the stainless steel wire. Eleven patients were followed up for a period from 2 months to 4 years, during which no translocation or broken of the titanium mesh was observed. Conclusions Radical en bloc excision remains the treatment of choice for sternal tumors. Sternum defect reconstruction using titanium mesh as a rigid replacement proves appropriate and effective.

Computer-Assisted Surgery for Mandibular Reconstruction Using a Patient-Specific Titanium Mesh Tray and Particulate Cancellous Bone and Marrow

Craniomaxillofacial surgery is difficult due to the complexity of the regional anatomy. Computer-assisted surgery is a promising tool aiming to improve the safety and precision of such surgery. A computer-assisted surgical navigation approach for reconstruction of mandibular defects using a patient-specific titanium mesh tray and particulate cancellous bone and marrow (PCBM) harvested from bilateral anterior ilia is proposed. This case report involves a large multicystic ameloblastoma affecting the right mandible of a 31-year-old male patient. Following detailed clinical examination, radiological interpretation, and histopathological diagnosis, computer-assisted surgical simulation with a virtual 3-dimensional (3-D) model was designed using surgical planning software based on the pre-operative computed tomography data. Long-span segmental resection of the mandible was planned, and the defect was analyzed for reconstruction using a patient-specific reconstruction titanium mesh tray mediated with computer-aided design and manufacturing (CAD/CAM) techniques. During the actual surgery, the ultrasonic bone cutting instrument in the surgeon’s hand was connected to the navigation system to touch an anatomical position on the patient. Therefore, osteotomies were performed finely and smoothly according to the navigation images of the cutting bone line by sequentially moving the instrument. Finally, a CAD/CAM-mediated titanium mesh tray condensed by PCBM was adapted to the remaining mandibular fragments. Six months postoperatively, the patient had a good mandibular configuration and facial contour. Integration of different technologies, such as software planning and 3-D surgical simulation, combined with intraoperative navigation and CAD/CAM techniques, provides safe and precise mandibular reconstruction surgery.

Titanium mesh fusion device in the treatment of thoracolumbar burst fracture

Thoracolumbar burst fracture, a common condition in clinic, often leads to severe spinal instability and neurologic deficit. In most cases, the compression that caused by backward protrusion of the fracture fragments to the spinal cord, makes complete decompression difficult through a posterior approach. Here, we reviewed the clinical records of 22 patients with thoracolumbar burst fracture treated by anterior corpectomy, decompression of the spinal cord, and implantation of titanium mesh cage.

Research Progress of Titanium Polypropylene Mesh in Breast Reconstruction

To investigate the application of titanium polypropylene mesh in breast reconstruction.In this study,we selected the literature data in recent 4 years to analyze the application of titanium polypropylene mesh in breast reconstruction.Using the keywords of"breast reconstruction,""titanium polypropylene mesh,^^"application"and"research progress,we analyzed and summarized the related research progress of titanium polypropylene mesh in breast reconstruction.The research was conducted using the analysis of titanium polypropylene mesh,titanium polypropylene mesh in breast reconstruction surgery advantages,adverse complications related to titanium polypropylene mesh in breast reconstruction surgery and preventive measures.By constantly improving these aspects in the research process,the current study has certain value,and may guide the research work of titanium mesh in breast reconstruction.

旋转超声加工对TiBw网状钛基复合材料表面残余应力的影响

为研究不同切削条件下旋转超声加工对材料表面残余应力的影响,选取硼化钛晶须(TiB whiskers,TiBw)网状钛基复合材料为实验对象,使用镍基电铸金刚石砂轮进行旋转超声加工,并分析了加工后材料的表面残余应力。结果表明:由于钛基复合材料具有网状结构和优异的高温性能,使切削热和微观相变产生的残余应力较小,磨粒机械作用产生的残余应力更大。随着超声振动的引入,磨粒高频冲击工件表面,使旋转超声加工工件表面残余应力均大于普通磨削。在主轴转速n=9000 r/min,进给速度v f=8 mm/min,加工深度a p=25μm的加工参数下,旋转超声加工工件表面存在-540 MPa的残余压应力,随着主轴转速增大,残余应力显著减小,并且残余应力的影响层深度逐渐减小。超声振动的引入增大工件表面残余压应力,提高材料抗疲劳性能。

钛网上CdS纳米微球的制备及可见光下产氢性能研究

为了提高催化剂的光催化产氢能力,本文采用简单的水热法,在处理后的钛网表面生长了CdS纳米微球。利用X射线衍射仪(XRD)、扫描电子显微镜(SEM)、透射电子显微镜(TEM)和X射线光电子能谱(XPS)等测试手段对样品的成分、结构、形貌进行了表征,并研究了其光电化学性能及可见光下光催化性能。结果表明,钛网上生长的CdS微球由纳米棒组装而成,通过缺陷调控,Cd/S物质的量之比为1∶1(CdS-1)的样品具有良好的光电响应,在零偏压下最大光电流约为140μA,可见光下的产氢率可达212.6μmol·h^(-1)·cm^(-2),并且方便回收,是一种理想的光催化产氢材料。

Mimics软件三维重建技术行钛网形态优化设计在颅骨成形术中的应用

目的探讨应用Mimics软件三维重建技术进行钛网形态优化设计在颅骨成形术中的应用效果。方法2017年5月至2022年5月前瞻性进行颅骨成形术60例,其中30例应用Mimics软件三维重建技术进行钛网形态优化设计(优化组),30例应用常规设计的钛网(对照组)。结果与对照组比较,优化组手术切口供血良好率明显增高(80.0%vs.53.3%;P=0.028),术后切口甲级愈合率明显增高(70.0%vs.40.0%;P=0.020),术后拆线时间明显缩短[(7.07±0.95)d vs.(7.83±1.12)d;P=0.006],术后大量硬膜外积液发生率明显降低(10.0%vs.36.7%;P=0.015)。优化组术后无颅内出血、钛网外露情况。结论应用Mimics软件三维重建技术对钛网形态进行优化设计,可有效降低颅骨成形术中切口缝合的张力,术后切口供血和愈合更佳,缩短术后拆线时间,降低大量硬膜外积液的发生率,有效减少颅内出血和钛网外露。

3D打印金属椎体替代物力学性能评价

目的 对钛网及3D打印金属椎体替代物力学性能进行研究,为临床中人工椎体选择与结构优化设计提供指导。方法 通过压缩力学测试,对钛网及3D打印多孔型、桁架型与拓扑型椎体替代物的等效力学属性与结构破坏形式进行系统研究。结果 钛网等效弹性模量[(2 908.73±287.39) MPa]仅次于拓扑型椎体替代物,但其结构强度与稳定性较差,等效屈服强度[(46.61±4.85) MPa]高于多孔型椎体替代物,且在压缩中率先屈服;多孔型椎体替代物结构强度[(18.14±0.17)~(25.79±0.40) MPa]不足,难以满足脊柱重建力学要求;桁架型椎体替代物等效弹性模量[(2 477.86±55.19)~(2 620.08±194.36)MPa]与等效屈服强度[(77.61±0.50)~(88.42±1.07) MPa]良好但稳定性不足,在压缩过程中容易出现失稳现象;拓扑型椎体替代物具有最高的等效弹性模量[(3 746.28±183.80) MPa]与等效屈服强度[(177.43±3.82) MPa],可为人工椎体在体服役安全稳定提供更强保障。结论 拓扑优化方法可实现椎体替代物高强度、高稳定性设计,提供更大的设计空间与安全余量,为人工椎体轻量化与新材料设计提供更多可能。

自制负压封闭引流装置联合扩张头皮皮瓣修复钛网外露创面一例

目的探讨自制负压封闭引流装置联合扩张头皮皮瓣修复钛网外露创面的可行性。方法对颅骨修复术后钛网外露、钛网下窦道存在患者采用自制负压封闭引流装置培养肉芽肿组织,至创面感染控制后,行钛网外头皮皮瓣扩张术。待钛网下肉芽完全生长填塞,钛网外扩张皮瓣达到能够无张力覆盖钛网创面,再行扩张头皮皮瓣移植覆盖钛网创面,创面外VSD持续负压吸引,观察皮瓣存活情况,皮瓣张力以及切口恢复情况。结果术后扩张皮瓣完全无张力覆盖钛网创面,皮瓣无缺血淤血,皮瓣切口无明显张力,皮瓣存活良好。结论自制负压封闭引流装置联合扩张头皮皮瓣修复钛网外露创面效果较好,继续扩展病例数量,观察疗效,如能继续保持较好疗效,临床可以考虑推广使用。

钛网植骨联合上颌窦底提升术改善上颌磨牙区严重骨缺损病例1例

目的面对上颌磨牙区偏离牙弓曲线水平向严重缺损伴骨高度不足,本病例尝试选用钛网作为支架,联合上颌窦底提升术实现局部区域的水平向和垂直向骨增量。方法患者术前CBCT显示,26牙位处剩余骨宽度约3.3 mm,高度约4.9 mm,27牙位处剩余骨宽度约5.2 mm,高度约5.1 mm。病例治疗采用了钛网维持颊侧水平向成骨空间,采集自体骨混合人工骨植骨,并应用富血小板纤维蛋白,同时联合侧壁开窗上颌窦底提升术改善垂直向骨量。结果术后5个月,取出钛网,CBCT显示,26牙位处较术前骨宽度增加了2.0 mm,高度增加了3.2 mm;27牙位处较术前骨宽度增加了1.2 mm,高度增加了4.0 mm,获得了理想的骨增量效果。术后6个月,进行经牙槽嵴顶上颌窦底提升术和种植体植入术,种植体初期稳定性良好。术后1年,种植修复完成,CBCT显示,26牙位处较术前骨宽度增加了2.9 mm,高度增加了4.5 mm;27牙位处较术前骨宽度增加了0.9 mm,高度增加了6.6 mm,结果显示骨增量效果稳定,恢复了正常的咬合功能,并取得一定的美学效果改善。结论该病例结果表明,钛网植骨联合上颌窦底提升术可以获得较为充分稳定的骨增量效果,是一种可靠的用来改善上颌磨牙区骨量不足的方法。

双曲抛物面形态和传统近似牙槽嵴形态3D打印钛网的力学性能研究

目的探究双曲抛物面空间结构对个性化钛网的力学性能影响。方法使用3-Matic 15软件为牙槽嵴吸收患者的下颌骨三维模型进行虚拟骨增量,分别增量为双曲抛物面结构和近似牙槽嵴结构,并制作孔隙为圆形、三角形、四边形和六边形,厚度为0.2 mm、0.3 mm、0.4 mm的个性化钛网,构建有限元分析模型,施加力和约束,分析各组钛网的应力和位移。结果同一厚度下,不同孔隙结构的双曲抛物面钛网应力和位移均明显低于近似牙槽嵴形态的钛网;随厚度减小,各组钛网的应力和位移显著增加。结论双曲抛物面这一空间结构可以均匀的分散应力,减少个性化钛网的应力集中,减少钛网受力后的位移,使钛网兼具了良好的力学性能和较薄的厚度,降低了对软组织的刺激,减少钛网暴露的可能。

3D打印个性化钛网辅助下的引导骨再生与块状自体骨移植在复杂牙槽骨缺损重建中的临床回顾性研究

目的拟采用临床回顾性研究的方法,对比3D打印个性化钛网(3D-PITM)辅助下的引导骨再生(guided bone regeneration,GBR)与块状自体骨移植在复杂牙槽骨缺损重建中的骨增量效果。方法纳入2018年5月至2022年1月就诊于重庆医科大学附属口腔医院种植科的39名牙槽骨缺损种植患者,根据其骨增量术式不同分为3D-PITM+GBR组(19名)和自体骨Onlay组(20名)。术前拍摄CBCT影像导入Mimics-Research和3-Matic软件进行三维重建与数字化设计,采用计算机辅助设计(CAD)/激光选区熔融(SLM)技术制作3D-PITM。术中固定3D-PITM或自体骨块完成相应的骨增量手术。收集患者术前、植骨术后、术后6~9个月、种植体植入后的CBCT影像资料。基于CBCT数字影像资料,分别测量两组患者在种植体中轴线上牙槽骨增加的高度,以及在种植体平台下方0 mm、2 mm、4 mm处牙槽骨增加的宽度,并计算其成骨率。结果3D-PITM+GBR组在骨增量前后和种植前后的垂直骨增量[2.68 mm(0.45,4.23)、2.27 mm(0.49,3.27)]均高于块状自体骨移植[1.60 mm(0.33,1.62)、1.74 mm(0.53,1.60)]。3D-PITM+GBR组在骨增量前后牙槽嵴顶下方0 mm、2 mm、4 mm平均骨宽度增量[(1.97±0.97)mm、(2.59±1.22)mm、(2.94±1.50)mm]高于块状自体骨移植[(1.06±0.99)mm、(1.45±1.25)mm、(2.32±1.23)mm]。3D-PITM+GBR组在种植前后种植体平台下方0 mm、2 mm、4mm平均骨宽度增量[(2.34±1.09)mm、(2.53±1.48)mm、(2.85±2.20)mm]反低于块状自体骨移植[(2.51±1.34)mm、(3.04±1.73)mm、(3.38±1.94)mm]。3D-PITM+GBR组在水平方向和垂直方向的成骨率(66.8%,68.8%)均高于块状自体骨Onlay移植组(64.6%,62.6%)。3D-PITM用于重建复杂牙槽骨缺损能够较块状自体骨移植明显提高牙槽骨重建的高度和宽度,但植入物暴露率(21%)仍高于自体骨Onlay组(5%)。结论3D-PITM+GBR技术可代替块状自体骨移植用于重建复杂牙槽骨缺损,获得理想的骨增量效果和稳定的骨轮廓,但钛网暴露仍是其应用的常见并发症。

自体骨-异种骨混合的钛网支撑的引导骨再生伴角化龈增量的美学区连续牙列缺损种植修复一例

本病例报告了一例自体骨-异种骨混合的钛网支撑的引导骨再生(guided bone regeneration,GBR)伴角化龈增量的美学区连续牙列缺损种植修复。患者因外伤致上颌前牙区骨折、水平向骨丧失,连续多颗天然牙缺失。临床治疗取自体骨混合去蛋白牛骨矿物质(deproteinized bovine bone mineral,DBBM)异种骨填入骨缺损区,在唇侧放置钛网和生物可吸收性胶原膜。半年后行简易修复导板引导下种植体植入,二期术前行角化龈增量,临时修复体佩戴6个月后完成最终美学修复。结果可见,自体骨-异种骨混合的钛网支撑的GBR获得了理想的骨增量效果,为种植体植入提供了理想的位点,同时角化龈增量手术为最终美学修复提供了令医患满意的临床效果。因此,自体骨-异种骨混合用于钛网支撑的GBR是一种增加前牙区水平骨量的有效方法。

股前外侧皮瓣在头面部较大软组织缺损修复中的应用

目的:探讨股前外侧游离皮瓣修复头面部软组织缺损的临床应用效果。方法:选取2018年8月-2022年10月就诊于笔者科室的头面部皮肤及皮下组织缺损并行游离皮瓣修复术的患者(其中男4例,女2例,年龄46~62岁)进行回顾性分析,头面部软组织缺损面积为8.0 cm×5.0 cm~18.0 cm×14.0 cm,部分可见颅骨及钛网外露。彻底清创后,切取合适大小股前外侧游离皮瓣予以封闭创面,切取皮瓣面积为13.0 cm×10.0 cm~20.0 cm×15.0 cm。大腿供皮区予以直接间断缝合或刃厚游离皮片移植加压包扎。术后随访3个月~1年,观察皮瓣存活、瘢痕、功能恢复及满意度情况。结果:6例移植皮瓣全部存活,外观良好,无明显瘢痕增生、牵拉移位及功能障碍,患者满意度良好。结论:对于头面部较大软组织缺损患者,采用股前外侧游离皮瓣移植是一项临床可行且效果良好的修复方式。

钛网支撑的引导骨再生的专家共识

目前,钛网支撑的引导骨再生(尤其是3D打印个性化钛网支撑的引导骨再生)的临床应用越来越多,是许多骨缺损病例(尤其是复杂骨缺损病例)种植手术时骨增量的一种可靠解决方案。鉴于钛网支撑的引导骨再生技术敏感性较强,钛网暴露并发症的发生风险较高,目前国内外尚缺乏相关的指南或共识,《中国口腔种植学杂志》编辑部组织相关专家讨论并起草了本共识,以期为临床提供参考依据。

Anatomy-related risk factors in Harm's mesh subsidence in cervical reconstruction after one-level corpectomy

Objective:To clarify anatomy-related factors in the cervical spine with subsidence of titanium mesh cage (TMC) after one-level cervical corpectomy and fusion. The effect of the cervical posture, segmental curvature and endplate gradient on this postoperative phenomenon was evaluated. Methods: Between August 2003 and March 2006, a total of the 236 patients underwent one-level corpectomy and TMC fusion. Their radiological examinations were reviewed and clinical outcomes evaluated. Results: In the patients who were followed up for 12 months, TMC subsidence occurred in 54 (28.6%) cases. C6 corpectomy had a significant higher risk (26/60, 43.3%) for TMC subsidence, which was correlated with the variation of the gradient of the vertebral endplates against cervical levels. Although the clinical outcome was comparable with those in the literature, the patients may have subsidence-related problems such as neck-shoulder pain, neurological deterioration and instrumental failure. Conclusion: To decrease the incidence of subsidence, TMC design should be optimized to be in line with anatomic characteristics of the cervical spine.

3D打印人工椎体在颈椎脊索瘤全脊椎切除术中的应用

目的:通过比较颈椎脊索瘤全脊椎切除术后3D打印人工椎体和钛网下沉率的差异,探讨3D打印人工椎体重建前方椎体能否减少术后内植物的下沉。方法:回顾性分析2005年3月至2019年9月在北京大学第三医院行全脊椎切除术的24例颈椎脊索瘤患者资料,其中采用3D打印人工椎体重建颈椎前方椎体(3D椎体组)有9例,采用钛网重建(钛网组)有15例。收集患者的年龄、性别、椎体CT值、手术信息(手术节段、手术时间、出血量及围手术期并发症)和术后内植物下沉等随访资料,采用SPSS 22.0进行数据分析。结果:比较两组患者的性别、年龄、椎体CT值、手术节段、手术时间、出血量及围手术期并发症,差异无统计学意义。术后3个月随访内植物下沉显示,3D椎体组有8例椎体高度下降<1 mm(无内植物下沉),1例椎体高度下降>1 mm(轻度内植物下沉);钛网组有5例椎体高度下降<1 mm(无内植物下沉),8例椎体高度下沉>1 mm(轻度内植物下沉),2例缺失术后3个月的影像学资料,两组3个月内植物下沉率的比较差异有统计学意义(P<0.05)。术后12个月随访内植物下沉显示,3D椎体组有8例椎体高度下降<1 mm(无内植物下沉),1例椎体高度下沉>3 mm(重度内植物下沉);钛网组有4例椎体高度下降<1 mm(无内植物下沉),2例椎体高度下沉>1 mm(轻度内植物下沉),9例椎体高度下沉>3 mm(重度内植物下沉),两组12个月内植物下沉率的比较差异有统计学意义(P<0.01),且两组的重度内植物下沉率(椎体高度下沉>3 mm)比较差异有统计学意义(P<0.05)。术后24个月随访内植物下沉显示,3D椎体组死亡1例,7例椎体高度下降<1 mm(无内植物下沉),1例椎体高度下沉>3 mm(重度内植物下沉);钛网组死亡1例,失访1例,1例椎体高度下降<1 mm(无内植物下沉),1例椎体高度下沉>1 mm(轻度内植物下沉),11例椎体高度下沉>3 mm(重度内植物下沉),两组24个月内植物下沉率比较差异有统计学意义(P<0.01),且两组的重度内植物下沉率比较差异有统计学意义(P<0.01)。结论:在颈椎脊索瘤的全脊椎切除术中,3D打印人工椎体可提供可靠的即刻和中远期的颈椎稳定性,与钛网重建相比,能够减少术后内植物下沉的发生率。