仿生材料修补儿童颅骨缺损的术后并发症探究  

Postoperative complications of pediatric biomimetic materials bone cranioplasty

作　　者：陈拓宇[1] 张玉琪[1] 薛超强[1] 潘鑫[1] 张庆琳[1] Chen Tuoyu;Zhang Yuqi;Xue Chaoqiang;Pan Xin;Zhang Qinglin(Department of Neurosurgery,Tsinghua University,Yuquan Hospital,Beijing 100040,China)

机构地区：[1]清华大学玉泉医院神经外科,北京100040

出　　处：《中华小儿外科杂志》2020年第7期607-612,共6页Chinese Journal of Pediatric Surgery

基　　金：国家十三五重点研发计划(SQ2019YFC110044-02)。

摘　　要：目的:探讨颅骨缺损患儿行仿生材料颅骨修补术后并发症的种类及预防方法。方法:回顾性分析2014年1月至2017年8月清华大学玉泉医院神经外科采用经个性化定制的仿生骨材料(纳米相羟基磷灰石/胶原复合骨)行儿童颅骨修补65例。其中,男36例,女29例;年龄范围为1岁2个月至12岁。外伤致去骨瓣57例,其中闭合性颅脑损伤49例(包括外伤后颅骨凹陷性/粉碎性骨折,硬膜内、外血肿,脑挫裂伤等),开放性颅脑损伤8例(包括车祸伤4例,高空坠物砸伤2例,钝器砸伤1例,锐器砍伤1例),非外伤因素去骨瓣减压8例(包括自发性蛛网膜下腔出血3例,脑肿瘤术后脑水肿2例,颅骨恶性肿瘤2例,颅骨嗜酸性肉芽肿1例)。平均去骨瓣时间为1年5个月,其中最短时间为2个月,最长时间超过4年。所有病例中,59例为单侧颅骨缺损(左侧36例,右侧23例),6例为双侧颅骨缺损;去骨瓣范围中标准或近似标准的单侧额颞大骨瓣减压窗46例,单侧额、颞、顶、枕部分去骨瓣减压13例,分隔的双侧额颞减压窗5例,双额贯通减压窗1例。术后跟踪随访2~5年。结果:患儿手术过程均顺利,出现各类术后并发症共42例,包括皮下积液27例,仿生材料固定松动8例,仿生材料术后碎裂6例,感染1例,全部行针对性处理后效果满意。结论:儿童仿生材料颅骨修补术后易出现各类并发症,这与术中仿生材料使用经验不足和儿童依从性差有关。掌握仿生材料的特性和儿童生长发育特点,可明显减少术后并发症的出现。Objective To explore the postoperative complications with biomimetic materials bone(nano-hap/collagen composites)cranioplasty in children.Methods From January 2014 to August 2017,retrospective analysis was performed for clinical data of 65 children with skull defects undergoing cranioplasty with biomimetic material bone(nano-hap/collagen composites).There were 36 boys and 29 girls with an age range of 14 to 144 months.Among 57 cases of craniectomy due to brain trauma,there were closed brain trauma(n=49)(hematoma and other causes of intracranial hypertension)and open brain trauma(n=8)(traffic accident injury,n=4;falling injury,n=2;blunt injury,n=1;chop injury,n=1).Eight cases were non-traumatic craniectomy(n=8)(spontaneous subarachnoid hemorrhage,n=3;cerebral hernia after brain tumor resection,n=2;skull malignant tumor,n=2;skull eosinophilic granuloma,n=1).The average time after craniectomy was 17(2-48)months.The defects were left(n=36),right(n=23)and bilateral(n=6).Approximate standard frontal-temporal-parietal decompressive craniectomy(n=46),unilateral craniectomy(n=13)(including frontal,frontotemporal or occipital skull),bone bridge in middle route of skull(n=5)and bilateral frontal bone crossing middle line(n=1)were performed.The follow-up period was from 2 to 5 years.Results Biomimetic materials bone cranioplasties were all successful.However,42 of them had such complications as subcutaneous hydrops(n=27),flap loosening(n=8),flap splintering(n=6)and infection(n=1).Conclusions Cranioplasty with biomimetic material bone is more prone to complications in children.It may be due to operative inexperience and poor compliance.Elucidating the physicochemical properties of biomimetic material bone and understanding the development characteristics may lower the occurrences of complications.

关 键 词：仿生材料 颅骨缺损 颅骨修补术 并发症 儿童 

分 类 号：R736.5[医药卫生—肿瘤]