颅骨缺损修补术后植入物外露的治疗策略及疗效分析  

Treatment strategy and therapeutic effect analysis of implant exposure after skull defect repair

作　　者：陈佳磊 何征晖 冯军峰[2] 惠纪元[2] 毛青[2] 江基尧[2] Chen Jialei;He Zhenghui;Feng Junfeng;Hui Jiyuan;Mao Qing;Jiang Jiyao(Department of Neurosurgery,the Second Affiliated Hospital of Nantong University(Nantong First People′s Hospital),Nantong 226001,China;Brain Injury Center,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200217,China)

机构地区：[1]南通大学第二附属医院(南通市第一人民医院)神经外科,南通226001 [2]上海交通大学医学院附属仁济医院颅脑创伤中心,上海200127

出　　处：《中华神经外科杂志》2023年第4期390-394,共5页Chinese Journal of Neurosurgery

基　　金：上海市优秀学术/技术带头人计划(21XD1422400);上海市医苑新星杰出青年医学人才项目(20224Z0012)。

摘　　要：目的探讨颅脑外伤患者因去骨瓣减压术后颅骨缺损行颅骨修补术,术后植入物(钛网和聚醚醚酮)外露的治疗策略及其疗效。方法回顾性分析2012年5月至2020年10月南通大学第二附属医院(南通市第一人民医院)神经外科(10例)和上海交通大学医学院附属仁济医院颅脑创伤中心(15例)收治的25例颅骨缺损修补术后植入物外露患者的临床资料。根据患者外露创面是否存在感染、外露时长、大小、形态,个体化决定是否行手术治疗及是否去除修补材料。若存在皮下感染,则清除感染病灶并去除修补材料。以患者术后伤口愈合情况作为疗效指标。患者于出院后1、3、6、12个月进行门诊复诊,随访伤口愈合、外观修复、生活质量情况。结果25例患者中,23例为钛网外露,2例为聚醚醚酮外露;13例(52.0%)患者植入物外露同时伴有伤口感染。2例局部感染的钛网修补患者通过非手术治疗最终痊愈,另外23例行手术治疗。手术患者中,10例患者通过旋转皮瓣保留了修补材料,13例去除了材料。25例患者术后12个月随访时,去除材料的患者中有11例再次进行了修补;所有患者伤口愈合良好,生活质量无影响。结论颅脑外伤患者颅骨修补术后植入物外露常伴有伤口感染。仅伤口局部感染的患者可以考虑非手术治疗;对于不伴皮下感染的患者可以选择旋转皮瓣覆盖创面以保留原修补材料,而对于存在皮下感染的患者应当去除修补材料,考虑远期再次修补。经个体化治疗,患者伤口愈合良好,且不影响生活质量。Objective To explore the treatment strategy and therapeutic effect of postoperative implant(titanium mesh or polyetheretherketone,PEEK)exposure in patients with craniocerebral trauma who underwent cranioplasty for skull defect after craniectomy.Methods A retrospective analysis was conducted on the clinical data of 25 patients with implant exposure after skull defect repair from May 2012 to October 2020 at the Department of Neurosurgery,the Second Affiliated Hospital of Nantong University(Nantong First People′s Hospital)(10 cases)and the Brain Injury Center,Renji Hospital,Shanghai Jiaotong University School of Medicine(15 cases).According to whether there was infection,exposure time,size,and shape of the patient′s exposed wound,an individual decision was made on whether to perform surgical treatment and whether to remove repair materials.If subcutaneous infection was present,the infected lesion should be aggressively debrided and the prosthetic material removed.The postoperative wound healing was used as the index of therapeutic effect.Patients were followed up on wound healing,appearance restoration,and quality of life at 1,3,6,and 12 months after discharge.Results Among the 25 patients,23 had titanium mesh exposure,2 had PEEK exposure;13(52.0%)patients had implant exposure accompanied by wound infection.Two cases of locally infected titanium mesh repair patients were cured by non-surgical treatment,and the other 23 cases were treated by surgery.Among the surgical patients,10 patients had the repair material preserved by the rotation flap,and 13 had the material removed.During the 12 months follow-up of 25 patients,11 of the patients whose material was removed were repaired again;all patients healed well,and the quality of life was not affected.Conclusions Implant exposure after cranioplasty in patients with traumatic brain injury is often accompanied by wound infection.Non-surgical treatment can be considered for patients with only local wound infection.For patients without subcutaneous infection,a rotation

关 键 词：再手术 手术后并发症 颅骨修补 植入物外露 

分 类 号：R651.1[医药卫生—外科学]