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 inclinic, often leads to severe spinal instability andneurologic deficit. In most cases, the compression thatcaused by backward protrusion of the fracture fragmentsto the spinal cord, makes complete decompressiondifficult through a posterior approach. Here, we reviewedthe clinical records of 22 patients with thoracolumbarburst fracture treated by anterior corpectomy,decompression of the spinal cord, and implantation oftitanium 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。

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。

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。

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。

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。

聚醚醚酮材料在大骨瓣去除术后颅骨修补患者中的临床应用

目的 探讨聚醚醚酮材料(PEEK)在大骨瓣缺损患者颅骨修补术中的应用及临床疗效。方法 回顾性分析上海交通大学医学院苏州九龙医院神经外科2018年10月—2021年9月收治的48例大骨瓣减压术后行颅骨修补术的患者的临床资料,其中PEEK材料修补的PEEK组共21例,三维钛网修补的钛网组共27例,分析两组手术材料费用,术后并发症发生率,手术时间,塑形满意度等方面的差异。结果 所有患者均康复出院,未出现术后感染,植入物裸露,癫痫等并发症。PEEK组皮下积液发生率、手术材料费用和塑形满意度明显高于钛网组;手术时间、术后气颅发生率、颅内出血发生率两组间无明显差异。PEEK组患者中有3例患者出现大量皮下积液,有1例大量皮下积液患者出现对侧肢体肌力下降,经抽吸及加压包扎后康复出院。结论 PEEK材料可安全有效地应用于颅骨修补术,能够完美恢复颅骨的解剖结构,不影响术后CT检查;但价格昂贵,需根据患者个体情况选用。

堆叠碳纤维电极在膜电容去离子脱盐中的应用

为了提高电化学脱盐装置中电极总吸附容量及脱盐性能,提出一种将堆叠碳纤维作为电极,且在电极之间加入钛网提升电极片层间导电性的方法。采用控制变量法设计脱盐实验,考察进水盐质量浓度、堆叠碳纤维电极厚度、增加钛网导体对脱盐性能的影响,并从吸附热力学和动力学角度分析吸附过程。结果表明:堆叠碳纤维电极会导致脱盐效率有所下降,其每层吸附容量由9.74 mg/g下降到2.86 mg/g。但通过增加多层钛网作为导电体可以有效提升脱盐速度,当增加至3层时,装置的脱盐速度较单层提高了2.1倍。堆叠碳纤维电极可解决单层电极吸附容量有限和无法长时间处理高浓度含盐水的问题,加入钛网可有效提升多层电极的导电性,从而提升脱盐性能。所提方法可为多层电极的设计及提升电极导电性提供新思路,对于电容去离子的工程化应用具有指导意义。

聚四氟乙烯膜改性个性化钛网的制备及其抗菌性能研究

目的通过在个性化钛网表面制备聚四氟乙烯膜,改善个性化钛网表面生物相容性和抗菌性能。方法采用白刚玉对个性化钛网表面进行喷砂粗化并空气喷涂聚四氟乙烯分散液,烧结热固化成膜以获得聚四氟乙烯膜改性个性化钛网(PMTM)。实验分组为激光选区熔融打印未处理(CON)、机械抛光(MP)、低粒径喷砂(SB)、成品钛加强致密性聚四氟乙烯膜(TRDP),分析试样表面形貌、粗糙度、亲水性、官能团、物相组成。对与金黄色葡萄球菌和大肠杆菌共培养后各组试样表面黏附的细菌数量及形态进行分析,评估聚四氟乙烯膜改性个性化钛网的体外抗菌能力。结果PMTM组表面形成稳定结合、高纯度的聚四氟乙烯薄膜,使改性的个性化钛网表面微米尺度粗糙度下降,高度疏水。CON组表面细菌量最多(P<0.001),MP、SB组表面细菌黏附数量较低。PMTM及TRDP组细菌黏附量相对最低,两者抗细菌黏附效果相近(P>0.05)。结论在个性化钛网表面制备聚四氟乙烯膜可以抑制细菌黏附,是一种较为理想的个性化钛网表面处理手段。

钛网联合帐篷螺钉技术与自体骨移植在前牙区水平骨增量的对比:一项回顾性研究

目的本回顾性研究以钛钉为参考平面,比较钛网联合帐篷螺钉技术与自体骨移植在前牙区牙槽嵴水平向骨增量的效果。方法研究纳入16例(共23个测量位点)前牙区牙槽嵴水平向骨量严重不足的患者。分别采用钛网联合帐篷螺钉技术与自体骨移植进行牙槽嵴水平向骨增量。收集骨增量后即刻及6个月的CBCT数据,以钛螺钉为参考面分别在牙槽嵴顶(crestal width,CW)、中段(midway width,MW)、基底(basal width,BW)3个平面进行骨宽度的测量,同时对骨增量面积进行重建对比,并对钛网是否暴露进行了评价。结果钛网联合帐篷螺钉技术与自体骨移植在CW、MW、BW 3个测量平面的骨增量宽度及吸收率基本相同,差别无统计学意义;两组获得的骨增量面积和吸收率基本相同,无统计学差异。然而,钛网暴露组在3个测量平面的宽度吸收均显著高于钛网未暴露组。薄龈生物型是钛网暴露的主要因素,后期钛网暴露经一定的抗感染治疗后也可达到临床可接受的骨增量效果。结论钛网联合帐篷螺钉技术与自体骨块移植都可获得临床可接受的骨增量效果。不过,如果钛网暴露,其骨吸收将显著增加。

3D打印聚醚醚酮材料修复颅骨缺损

背景:在进行颅骨重建过程中,采用不同颅骨修补材料的术后效果有一定区别,术后并发症的发生也有较大差异。目的:探讨采用3D打印聚醚醚酮材料行颅骨缺损成形的临床效果。方法:选择蚌埠医学院第一附属医院2016年2月至2020年8月收治的112例颅骨缺损患者,其中男67例,女45例,均进行颅骨重建手术,其中36例使用3D打印聚醚醚酮材料,76例使用三维钛网材料。术后随访观察两组并发症发生情况,包括皮下积液、脑积水、硬膜外或硬膜下血肿、切口愈合不良或植入物外漏、感染等。结果与结论:①聚醚醚酮组、钛网组患者分别获得术后(14.64±2.39),(15.49±2.17)个月随访,组间比较差异无显著性意义(P>0.05);两组均未出现因植入物材料原因导致植入失败的患者;②钛网组中33例患者出现并发症,其中1例为脑积水、9例为皮下积液、3例为硬膜外/下血肿、13例为切口愈合不良、3例为植入物外露、颅内感染4例,并发症发生率为43.4%;聚醚醚酮组中10例患者出现并发症,其中6例为皮下积液、1例为硬膜外/下血肿、2例为切口愈合不良、1例为颅内感染,并发症发生率为27.8%;两组术后总并发症发生率比较差异无显著性意义(P>0.05),但切口愈合不良/植入物外露发生率比较差异有显著性意义(P<0.05);③结果表明,3D打印聚醚醚酮修补材料在颅骨缺损修补应用中具有良好的生物相容性,且安全性、精确性较好,相对于钛网材料在切口愈合方面具有更好的优势。

仿生蛛网孔隙结构3D打印个性化钛网设计及三维有限元分析

背景:蜘蛛网结构具有内在的能量耗散机制,使其能承受较大的集中负荷,将其应用到3D打印个性化钛网设计上来减少由于应力集中引起的局部断裂。目的:研究新型仿生蛛网孔隙结构3D打印个性化钛网的设计方法,并应用三维有限元法对其进行生物力学分析。方法:应用锥形束CT、Mimics、Geomagic Wrap、3-matic Research和ANSYS Workbench等软件分别建立仿生蛛网孔隙结构、圆孔结构、方孔结构、六边形孔结构且厚度均为0.3 mm的4组个性化钛网有限元模型,将100 N的载荷加载在牙槽嵴顶对应的钛网上,进行有限元分析。结果与结论:①方孔、圆孔、六边形孔、仿生蛛网孔隙结构个性化钛网最大位移值分别为0.064,0.103,0.107,0.070 mm,等效应力最大分别为1633.5,1611.3,2131.2,1104.8 MPa;②各组固位螺钉在钛网受力后应力分布相似,主要集中在螺钉颈部与钛网相接触部位,方孔、圆孔、六边形孔、仿生蛛网孔隙结构个性化钛网组固位螺钉最大等效应力值分别为149.13,200.32,178.73,163.30 MPa,各组固位螺钉所受到的应力处于安全范围内;③结果显示,仿生蛛网孔隙结构个性化钛网能很好地分散钛网应力,减少应力集中现象;同时,0.3 mm厚度仿生蛛网孔隙结构个性化钛网可以满足大面积颌骨缺损重建机械强度的要求。