自体骨与钛网两种颅骨修补方案的疗效分析  

Efficacy analysis of autologous bone flap and titanium mesh repair schemes

作　　者：曹轲[1] 李宗正[1] 刘玉飞[2] 武弋[3] 段兴浩 杨振兴[1] 黄德俊[1] 万定[1] 田立庄[3] 朱迪[3] 季玮[3] 刘奇[3] 

机构地区：[1]宁夏医科大学,银川750004 [2]深圳市第二人民医院(深圳大学第一附属医院)神经外科 [3]兰州军区兰州总医院神经外科

出　　处：《中华神经外科杂志》2015年第9期918-922,共5页Chinese Journal of Neurosurgery

摘　　要：目的探讨自体冰冻颅骨修补与三维CT成型钛网修补两种颅骨修补方案的临床效果差异及其原因。方法对2008年1月至2010年12月216例因颅脑伤行开颅去骨瓣减压术后行自体冰冻颅骨修补的患者与同期139例行三维成型钛网修补的患者进行多中心对照研究，比较两方案术中出血量、手术持续时间、术后相关并发症的差异，以及不同时间窗修补术后术区近期（术后1个月内）及远期（术后1个月～3年）感染的差异。结果两种修补方案的术中平均出血量（t=10．205，P=0．000）、平均手术时间（t=13．957，P=0．000），术后术区不适（X^2=7．565，P=0．006）、惧冷热（，=167．389，P=0．000）、怕震动（X^2=146．654，P=0．000）等差异有统计学意义；而两方案术后出现继发性癫痫（P=0．563）、术区凹陷变形（P=0．304）的差异无统计学意义；自体骨早期修补组患者与钛网组全部患者相比，两方案术后整体感染率差异无统计学意义（X^2=0．007，P=0．931），但两方案的近期感染率（X^2=3．860，P=0．049）及远期感染率（r=3．962，P=0．047）的差异有统计学意义。结论控制自体骨组方案修补时间窗位在去骨瓣术后1～3个月内，临床效果较钛网修补的方案好，尤其在降低术后远期感染方面有明显优势。Objective To investigate the differences of clinical efficacy and its reason of cranioplasty using frozen autologous bone and three-dimensional CT titanium mesh repair schemes. Methods A multieenter controlled study was performed in 216 patients who underwent cranioplasty using frozen autologous bone after decompressive craniectomy because of craniocerebral injury from January 2008 to December 2010, and 139 patients were treated with three-dimensional titanium mesh at the same period. The differences of intraopcrative blood loss, duration of sm＇gery, and related complications after procedure, as well as the differences between the short- （within a month after surgery） and long-term （ 1 month to 3 years after surgery ） infections after procedure at different time windows of the two schemes were compared. Results There were significantly differences in intraoperative mean blood loss （ t = 10. 205, P = 0. 000 ） , mean operation time （t = 13. 957, P = 0. 000） , uncomfortable at the operated area after procedure （X2 = 7. 565, P = 0. 006） , fear of hot and cold （X2 = 167. 389, P = 0. 000） , and fear of vibration （X2 = 146. 654, P = 0. 000） between the two repair schemes. There were no significantly differences in secondary epilepsy （ P = 0. 563 ） and depres^c~d deformation at the surgery area （ P = 0. 304 ） between the two repair schemes. There was no significantly differences in the overall infection rate of the two schemes after procedure between the patients of the early autogenous bone repair group and those of the titanium mesh group （X2 = 0. 007, P = 0. 931 ） , however, there was significantly difference in the recent infection rate （X2 = 3. 860, P = 0. 049） and long-term infection rate （X2 = 3.962, P = 0. 047） between the two schemes. Conclusions The repair time window of the autologous bone group scheme was controlled within 1 to 3 months after craniectomy. The clinical effect was better than the titanium mesh repair scheme, in particular, it has obvious an adva

关 键 词：颅骨 感染 手术后并发症 成像 三维 钛 

分 类 号：R651.1[医药卫生—外科学]