颅骨缺损修补术中的组织重建技术  

Tissue reconstruction technique in skull defect neoplasty

作　　者：林震涛[1] 何理盛[1] 梅文忠[1] 

机构地区：[1]福建医科大学附属第一医院神经外科,福建省福州市350001

出　　处：《中国组织工程研究与临床康复》2007年第41期8294-8297,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：目的:颅骨缺损修补术中细节问题如不加以注意,可能会引发一些并发症。通过分组对比观察,探讨颅骨缺损修补手术中的组织构建技巧,以期提高此类患者的疗效,改善生活质量。方法:①对象:选择2000-01/2007-01颅盖骨缺损患者86例。②分组:将86例患者随机分两组,普通术式修复法组26例,其中男19例,女7例;年龄5～56岁;颞肌组织重建组60例,男51例,女9例;年龄8～69岁。颅盖骨缺损修补手术时间为缺损后1个月～6年。③干预:颞肌组织重建组:将钛网塑型,固定,将颞肌筋膜和肌肉呈扇形贴紧钛网表面,间断缝合颞肌筋膜和肌肉缘于钛网表面;普通术式修复法:采用翻转皮瓣,即颞肌筋膜外的皮瓣,显露出骨缺损区,覆盖钛网,直接把颞部肌肉全部盖在钛网下。④评估:对两组患者术后一般情况、咀嚼、疼痛、颞部肌肉萎缩、外观皮肤凹陷进行比较,并观察不良事件及副反应。结果:86例患者随访时间为1个月～6年。①颞肌组织构建患者术后咀嚼有力、头面部疼痛轻、颞部肌肉萎缩不明显、外观无或较轻皮肤凹陷。普通术式修复的患者出现临床症状,可能因为局部钛网压迫颞肌层,致咀嚼时疼痛、无力。②普通术式修复法出现钛网松动3例,经局部加压包扎固定1个月后好转;两组2例硬膜外血肿自行吸收;3例术后癫痫,治疗后得到良好控制。结论:颅骨缺损重建术中,组织重建尤为重要,特别要注意重建生理的组织结构。采用间断缝合颞肌筋膜和肌肉缘于钛网外面的方法处理,可防止术后患者咀嚼无力、疼痛和外观变形等并发症,并有利于术后尽快的生理修复,使患者尽早正常生活。AIM： Some problems in skull defect neoplasty may cause some complications. In this study, the technique of tissue reconstruction in skull defect neoplasty was investigated through grouping and comparative observation, so as to improve the curative effect and quality of life of patients. METHODS： （1）Eighty-six cases of skull defect were selected from January 2000 to January 2007, and randomly divided into normal reconstitution group （n =26） including 19 males and 7 females aged 5-69 years old and temporalis tissue restitution group （n =60） including 51 males and 9 females aged 8-69 years old. The defect neoplasty was carded out at one month to six years after defects. （2）In the temporalis tissue restitution group, titanium alloy mesh was modeled and fixed, then temporal muscle and temporaries fasciae were stuck on it and sutured. In normal reconstitution group, the book flap, the skin flap out of muscular fasciae, was used, and the bone defect was exposed and covered by titanium mesh. （3）The general condition, mastication, pain, temporal muscle atrophy, and external skin introcession of two groups were compared and the adverse effects and side reaction were observed. RESULTS： All 86 patients were followed up for 1 month to 6 years. （1）In the temporalis tissue restitution group, the patients showed powerful mastication, less pain, no temporal muscle atrophy or skin introcession. While the patients in normal constitution group presented clinical symptoms like pain in mastication, which might be caused by the oppression of titanium mesh. （2）There were 3 cases with titanium mesh loosening after normal repair, which was improved after local pressure dressing for 1 month. Two cases developed epidural hematoma and absorbed spontaneously, and 3 cases developed epilepsy, which was controlled well by medication. CONCLUSION： Tissue reconstruction is very importance in skull defect neoplasty. Physiological reconstruction of organization should be noticed in the surgery. The interrupted sutu

关 键 词：颅骨/损伤 颞肌 组织构建 

分 类 号：R683[医药卫生—骨科学]