矿化胶原仿生骨材料在颅骨缺损修补术中的临床应用  

Clinical application of mineralized collagen scaffolds in surgical treatment of skull defects

作　　者：陈拓宇[1] 王硕 李博 杨凯元 满韦韬 王秀梅 CHEN Tuoyu;WANG Shuo;LI Bo;YANG Kaiyuan;MAN Weitao;WANG Xiumei(Department of Neurosurgery,Beijing Tsinghua Changgung Hospital Affiliated to Tsinghua University,Beijing,102218,P.R.China;Key Laboratory of Advanced Materials of Ministry of Education,School of Materials Science and Engineering,Tsinghua University,Beijing,100084,P.R.China)

机构地区：[1]清华大学附属北京清华长庚医院神经外科,北京102218 [2]清华大学材料学院清华大学先进材料教育部重点实验室,北京100084

出　　处：《中国修复重建外科杂志》2024年第12期1427-1432,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家重点研发计划重点专项(2023YFC2412305)。

摘　　要：目的探讨矿化胶原(mineralized collagen,MC)骨支架在不同类型颅骨缺损修复中的临床应用价值,评估多孔MC支架(porous MC,pMC)、致密MC支架(compact MC,cMC)及双相MC复合支架(biphasic MC,bMC)的适用性及修复效果。方法回顾分析2014年10月—2022年4月105例应用pMC、cMC和bMC进行颅骨缺损修补的患者临床资料。男63例,女42例;年龄3个月~55岁,中位年龄22.7岁。颅脑外伤后去骨瓣减压导致颅骨缺损37例,单纯开颅手术导致颅骨缺损58例,因肿瘤复发或出血导致的二次手术开颅去骨瓣减压后颅骨缺损10例。颅骨缺损范围1.5~126.0 cm^(2)。根据患者颅骨缺损范围和年龄选择相应MC支架,58例颅骨缺损面积<3 cm^(2)者采用pMC行颅骨修补(pMC组),45例缺损面积≥3 cm^(2)且年龄≥5岁者采用cMC行颅骨修补(cMC组),2例缺损面积≥3 cm^(2)且年龄<5岁者采用bMC行颅骨修补(bMC组)。术后通过临床随访及影像学检查,评估术后骨再生、修复材料的生物相容性及并发症发生情况。结果105例患者均获随访,随访时间3~24个月,平均13个月。所有患者术后均无材料相关并发症发生,如皮肤及皮下组织感染、过度骨化、排斥反应。术后6个月头颅CT示均可见骨生长,术后12个月头颅CT示所有患者骨缺损完全消失或近全消失,pMC组58例均已修复。pMC组术后12个月缺损部位及对侧正常颅骨板的CT值分别为(1123.74±93.64)HU和(1128.14±92.57)HU,差异无统计学意义(t=0.261,P=0.795)。结论MC在颅骨缺损修复中展现出良好的生物相容性及成骨诱导能力,pMC适用于小面积缺损修复,cMC适合大面积缺损修复,而bMC适用于低龄儿童颅骨缺损修复。Objective To explore the clinical application value of mineralized collagen(MC)bone scaffolds in repairing various types of skull defects,and to assess the suitability and repair effectiveness of porous MC(pMC)scaffolds,compact MC(cMC)scaffolds,and biphasic MC composite(bMC)scaffolds.Methods A retrospective analysis was conducted on the clinical data of 105 patients who underwent skull defect repair with pMC,cMC,or bMC between October 2014 and April 2022.The cohort included 63 males and 42 females,ranging in age from 3 months to 55 years,with a median age of 22.7 years.Causes of defects included craniectomy after traumatic surgery in 37 cases,craniotomy in 58 cases,tumor recurrence or intracranial hemorrhage surgery in 10 cases.Appropriate MC scaffolds were selected based on the patient’s skull defect size and age:58 patients with defects<3 cm^(2) underwent skull repair with pMC(pMC group),45 patients with defects≥3 cm^(2) and aged≥5 years underwent skull repair with cMC(cMC group),and 2 patients with defects≥3 cm^(2) and aged<5 years underwent skull repair with bMC(bMC group).Postoperative clinical follow-up and imaging examinations were conducted to evaluate bone regeneration,the biocompatibility of the repair materials,and the occurrence of complications.Results All 105 patients were followed up 3-24 months,with an average of 13 months.No material-related complication occurred in any patient,including skin and subcutaneous tissue infection,excessive ossification,and rejection.CT scans at 6 months postoperatively showed bone growth in all patients,and CT scans at 12 months postoperatively showed complete or near-complete resolution of bone defects in all patients,with 58 cases repaired in the pMC group.The CT values of the defect site and the contralateral normal skull bone in the pMC group at 12 months postoperatively were(1123.74±93.64)HU and(1128.14±92.57)HU,respectively,with no significant difference(t=0.261,P=0.795).Conclusion MC exhibits good biocompatibility and osteogenic induction ability in

关 键 词：矿化胶原支架 颅骨缺损 生物相容性 成骨诱导 

分 类 号：R651.1[医药卫生—外科学]