自体颅骨瓣联合人工修复材料修复颅骨缺损的临床及基础研究
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摘要
研究目的
1、运用自体颅骨瓣联合人工修复材料修复复杂颅骨缺损,观察临床效果,分析该手术方法的优点及可能存在的问题。
2、探讨珊瑚人工骨作为人工骨支架在体内的成骨效能、成骨过程以及自体颅骨瓣联合珊瑚人工骨修复幼龄小型猪颅骨缺损的修复效果,为临床应用提供必要的实验依据。
方法
1、5例患者采用自体颅骨瓣联合高密度多孔聚乙烯(Medpor)进行修复复杂颅骨缺损,8例患者采用自体颅骨瓣联合钛板进行修复复杂颅骨缺损。对所有的患者进行随访,随访时间6至72个月。
2、本研究采用幼龄小型猪为研究对象,分为实验组和对照组。实验组和对照组分别为人为建立颅骨缺损模型、缺损不修复和人为建立颅骨缺损模型后用自体颅骨瓣联合珊瑚人工骨联合修复颅骨缺损。通过形态学、组织学、影像学观察等手段研究新骨形成过程,观察颅骨缺损修复效果。
结果
1、所有患者的颅骨轮廓都得到了很大的改善,同时还有很好的美容效果。无严重感染、修复材料外露、修复材料取出、头颅或修复材料轮廓变形等严重并发症发生。5例患者出现了血清肿,通过负压引流和加压包扎清除了血清肿。
2、自体颅骨植入后完全被新生骨替代,珊瑚人工骨被完全吸收形成新生骨,二者形成的新生骨在组织形态学等方面无明显区别,缺损被形成的新生骨完全修复。
结论
1、本研究表明自体颅骨瓣骨联合Medpor或个性化钛板对复杂性颅骨缺损进行修复可以取得较好的临床效果,为解决复杂颅骨缺损提供了一种有效的方法。
2、珊瑚人工骨在幼龄小型猪体内可以被吸收形成新生骨,自体颅骨联合珊瑚人工骨作为一种新方法可以有效的修复幼龄小型猪的颅骨缺损,为可能将此方法运用于临床提供了理论依据。
Purpose:
1. To observe the clinical effect of calvarial bone graft combined with alloplastic materials for complex calvarial defect, and analyse the advantage of the method of the surgery, and the problems that may exist.
2. To evaluate the effect of the osteogenesis of coral hydroxyapatite as artificial bone scaffolds and study the effect of this new method. Using cranial bone graft combined with coral hydroxyapatite in miniature pigs calvarial defect, provide the necessary experimental basis for clinical application.
Methods:
1. Eight patients with complex calvarial defects underwent cranioplasty with porous polyethylene combined with split calvarial bone graft. Five patients with complex calvarial defects underwent cranioplasty with titanium plate combined with split calvarial bone graft. Follow-up visits were conducted for6to72months to monitor the patients.
2. Three-month-old miniature pigs were used as experimental animals and were randomised into two groups. Experiment A:The osteotomy was performed on parietal bone and formation calvarial defect model, no repair. Experiment B:The osteotomy was performed on parietal bone and formation calvarial defect model, repaird by cranial bone graft combined with coral hydroxyapatite. Observation the osteogenesis and effect of this method by morphological, histological, radiological.
Results:
1. Significant improvements in the contour of the skulls as well as in the aesthetic appearance of all the patients were observed. Moreover, no serious complications, such as infections, exposure, removal of the implants, and contour or implant abnormalities were observed. Five cases displayed a transient extradural seroma collection, which was resolved through drainage and compression bandaging.
2. The calvarial bone graft was replaced by new bone, the coral hydroxyapatite was absorbed and replaced by new bone. There are no significant differences in the new bone, and the defect is totally repaired by new bone.
Conclusions:
1. The results of this pilot study indicate that the combined use of porous polyethylene or titanium plate and split calvarial bone graft may be useful for cranial reconstruction in patients with complex cranial defects.
2. Coral hydroxyapatite as artificial bone scaffolds can be absorbed and formed new bone. This new method of using calvarial bone graft combined with coral hydroxyapatite to covered calvarial defect in miniature pigs has well effect. This study provided a theoretical basis for clinical use of this new method.
1、运用自体颅骨瓣联合人工修复材料修复复杂颅骨缺损,观察临床效果,分析该手术方法的优点及可能存在的问题。
2、探讨珊瑚人工骨作为人工骨支架在体内的成骨效能、成骨过程以及自体颅骨瓣联合珊瑚人工骨修复幼龄小型猪颅骨缺损的修复效果,为临床应用提供必要的实验依据。
方法
1、5例患者采用自体颅骨瓣联合高密度多孔聚乙烯(Medpor)进行修复复杂颅骨缺损,8例患者采用自体颅骨瓣联合钛板进行修复复杂颅骨缺损。对所有的患者进行随访,随访时间6至72个月。
2、本研究采用幼龄小型猪为研究对象,分为实验组和对照组。实验组和对照组分别为人为建立颅骨缺损模型、缺损不修复和人为建立颅骨缺损模型后用自体颅骨瓣联合珊瑚人工骨联合修复颅骨缺损。通过形态学、组织学、影像学观察等手段研究新骨形成过程,观察颅骨缺损修复效果。
结果
1、所有患者的颅骨轮廓都得到了很大的改善,同时还有很好的美容效果。无严重感染、修复材料外露、修复材料取出、头颅或修复材料轮廓变形等严重并发症发生。5例患者出现了血清肿,通过负压引流和加压包扎清除了血清肿。
2、自体颅骨植入后完全被新生骨替代,珊瑚人工骨被完全吸收形成新生骨,二者形成的新生骨在组织形态学等方面无明显区别,缺损被形成的新生骨完全修复。
结论
1、本研究表明自体颅骨瓣骨联合Medpor或个性化钛板对复杂性颅骨缺损进行修复可以取得较好的临床效果,为解决复杂颅骨缺损提供了一种有效的方法。
2、珊瑚人工骨在幼龄小型猪体内可以被吸收形成新生骨,自体颅骨联合珊瑚人工骨作为一种新方法可以有效的修复幼龄小型猪的颅骨缺损,为可能将此方法运用于临床提供了理论依据。
Purpose:
1. To observe the clinical effect of calvarial bone graft combined with alloplastic materials for complex calvarial defect, and analyse the advantage of the method of the surgery, and the problems that may exist.
2. To evaluate the effect of the osteogenesis of coral hydroxyapatite as artificial bone scaffolds and study the effect of this new method. Using cranial bone graft combined with coral hydroxyapatite in miniature pigs calvarial defect, provide the necessary experimental basis for clinical application.
Methods:
1. Eight patients with complex calvarial defects underwent cranioplasty with porous polyethylene combined with split calvarial bone graft. Five patients with complex calvarial defects underwent cranioplasty with titanium plate combined with split calvarial bone graft. Follow-up visits were conducted for6to72months to monitor the patients.
2. Three-month-old miniature pigs were used as experimental animals and were randomised into two groups. Experiment A:The osteotomy was performed on parietal bone and formation calvarial defect model, no repair. Experiment B:The osteotomy was performed on parietal bone and formation calvarial defect model, repaird by cranial bone graft combined with coral hydroxyapatite. Observation the osteogenesis and effect of this method by morphological, histological, radiological.
Results:
1. Significant improvements in the contour of the skulls as well as in the aesthetic appearance of all the patients were observed. Moreover, no serious complications, such as infections, exposure, removal of the implants, and contour or implant abnormalities were observed. Five cases displayed a transient extradural seroma collection, which was resolved through drainage and compression bandaging.
2. The calvarial bone graft was replaced by new bone, the coral hydroxyapatite was absorbed and replaced by new bone. There are no significant differences in the new bone, and the defect is totally repaired by new bone.
Conclusions:
1. The results of this pilot study indicate that the combined use of porous polyethylene or titanium plate and split calvarial bone graft may be useful for cranial reconstruction in patients with complex cranial defects.
2. Coral hydroxyapatite as artificial bone scaffolds can be absorbed and formed new bone. This new method of using calvarial bone graft combined with coral hydroxyapatite to covered calvarial defect in miniature pigs has well effect. This study provided a theoretical basis for clinical use of this new method.
引文
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