中国组织工程研究

中国组织工程研究 ›› 2019, Vol. 23 ›› Issue (26): 4237-4242.doi: 10.3969/j.issn.2095-4344.1366

• 生物材料综述 biomaterial review • 上一篇    下一篇

自体同源颅骨作为颅骨成形材料的基础与临床研究进展

闫  可1，陆黎春1，赵海峰2，王为华1，朱文昱1，黄  强3 
  

  1. 南京医科大学附属苏州医院/苏州科技城医院，1神经外科，2病理科，江苏省苏州市  215153；3苏州大学附第二医院神经外科，江苏省苏州市  215004
  • 收稿日期:2019-03-26
  • 通讯作者: 朱文昱，临床医学硕士，副主任医师，南京医科大学附属苏州医院/苏州科技城医院神经外科，江苏省苏州市 215153
  • 作者简介:闫可，男，1990年生，内蒙古自治区呼和浩特市人，蒙古族，2017年苏州大学毕业，硕士，主要从事神经外科临床与基础研究。
  • 基金资助:

    苏州市科技局民生科技项目(SYS2018013)，项目负责人：朱文昱

Basic and clinical research progress of autologous skull as a material for cranioplasty

Yan Ke1, Lu Lichun1, Zhao Haifeng2, Wang Weihua1, Zhu Wenyu1, Huang Qiang3
  

  1. 1Department of Neurosurgery, 2Department of Pathology, Suzhou Hospital of Nanjing Medical University, Suzhou Science and Technology Town Hospital, Suzhou 215153, Jiangsu Province, China; 3Department of Neurosurgery, the Second Affiliated Hospital of Suzhou University, Suzhou 215004, Jiangsu Province, China
  • Received:2019-03-26
  • Contact: Zhu Wenyu, Master, Associate chief physician, Department of Neurosurgery, Suzhou Hospital of Nanjing Medical University, Suzhou Science and Technology Town Hospital, Suzhou 215153, Jiangsu Province, China
  • About author:Yan Ke, Master, Department of Neurosurgery, Suzhou Hospital of Nanjing Medical University, Suzhou Science and Technology Town Hospital, Suzhou 215153, Jiangsu Province, China
  • Supported by:

    Livelihood Creation Project of Suzhou Science and Technology Bureau No. SYS2018013 (to ZWY)

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摘要：

文章快速阅读：

 

文题释义：
自体同源颅骨成形术：是指从患者在去骨瓣减压术中取下的、日后用于同一患者颅骨成形术的一种手术方法。患者术后处于头颅骨瓣缺损状态，待有机会行颅骨修补术时将当时取下的颅骨瓣按原位复位，并妥善固定。
颅骨成形材料：有已被淘汰的有机玻璃和硅橡胶，目前盛行的钛网板和正在推广的陶瓷、聚醚醚酮都有不尽人意之处；人异体和自体骨(包括髂骨和颅骨)都被研究过，只有自体同源颅骨持续在试用，但仍有回植骨被吸收等不足，需要研究。
 
 
背景：颅骨成形术中，应用自体颅骨作为生物同源性和低成本而具有不可替代的优点，然而因回植后自体颅骨被吸收等问题长期得不到解决，而始终未能成为颅骨成形术的主流，反而有被3D塑形钛网完全替代的趋势。
目的：对目前临床及动物实验中自体颅骨回植的研究最新进展及自体同源回植骨被吸收的可能机制进行综述。
方法：应用计算机检索PubMed、中国万方、知网和生物医学文献等数据库(CBMdisc)中与自体同源颅骨成形术密切相关的临床和动物研究，检索时限为1990年1月至2019年1月。
结果与结论：①临床发现自体颅骨回植后的感染率和吸收率较高，完全移植成功率低的直接原因是未能优选到保存骨瓣的温度和灭菌的最佳方法，按指南及文献推荐的方法无法达到满意的移植效果；②目前探讨骨吸收和成骨机制主要以中小动物为主，较少见到摸拟临床的大骨瓣开颅后延期自体同源颅骨成形的研究；③在所有回植骨都持续存在程度不等的吸收和新生并存的背景下，同时根据临床大骨瓣开颅一期复位患者始终存在骨瓣与骨窗缘的缝隙问题，作者确认了扁平颅骨与四肢长骨存在骨诱导和骨传导不一样的愈合机制，并且应像器官移植一样，保存含有骨膜和硬脑膜的离体骨瓣，创造最佳的复苏条件，这才是今后努力的方向。

关键词: 颅脑创伤, 颅骨成形术, 自体同源颅骨, 骨瓣移植, 骨质吸收, 成骨机制, 临床观察, 动物实验

Abstract:

BACKGROUND: During cranioplasty, skull autografts have irreplaceable advantages because of its homology and low cost. However, skull autografts have not be preferred and tend to be substituted by 3D titanium mesh because they can be absorbed after re-implantation.
OBJECTIVE: To summarize the recent advances in re-implantation of skull autografts in clinical and animal experiments and the possible mechanisms underlying absorption of skull autugrafts.
METHODS: Clinical and animal studies related to cranioplasty with skull autografts published during January 1990-January 2019 in PubMed, China Biomedical Literature Database (CBMdisc), Wanfang Database and CNKI were retrieved.
RESULTS AND CONCLUSION: Clinically, the infection rate and absorption rate after re-implantation of skull autografts were more frequently reported. The direct causes of low success rate of complete graft are imperfect temperature and sterilization condition for preserving bone flaps. Animal experiments were mainly to explore the bone resorption and osteogenesis mechanism of small and medium-sized animals. Little is reported on the simulation of delayed autologous skull formation after large-scale craniotomy. In the context of absorbing and nascent coexistence in all re-implanted bone grafts, there was always a gap between the bone flap and the bone window edge in patients undergoing phase I reduction in craniotomy. The authors found that the flat skull and the long bone of the extremities have different mechanisms in osteoinduction and bone conduction, and isolated bone flaps containing periosteum and dura mater should be preserved for creating optimal resuscitation conditions, like organ transplantation. This will be addressed in future work.

Key words: craniocerebral trauma, cranioplasty, skull autograft, bone flap transplantation, bone absorption, osteogenesis mechanism, clinical observation, animal experiments

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