切换至 "中华医学电子期刊资源库"
高级检索
中华神经创伤外科电子杂志

中华神经创伤外科电子杂志 ›› 2021, Vol. 07 ›› Issue (02) : 82 -86. doi: 10.3877/cma.j.issn.2095-9141.2021.02.004

所属专题： 文献；

颅脑创伤

应用深低温保存自体颅骨治疗儿童继发性颅骨缺损的回顾性研究
车东方1, 廖传鹏1, 王靖生1, 刘悦琤1, 刘明刚1, 臧冬东1, 刘棋斌1, 陈乾1,†()   
  1. 1. 518038　深圳市儿童医院神经外科
  • 收稿日期:2021-01-19 出版日期:2021-04-15
  • 通信作者: 陈乾
  • 基金资助:
    深圳市医学重点学科（2020-2024）(SZXK035)

Cryopreservation of autologous cranial bone flaps for cranioplasty in children

Dongfang Che1, Chuanpeng Liao1, Jingsheng Wang1, Yuecheng Liu1, Minggang Liu1, Dongdong Zang1, Qibin Liu1, Qian Chen1,†()   

  1. 1. Department of Neurosurgery, Shenzhen Children’s Hospital, Shenzhen 518038, China
  • Received:2021-01-19 Published:2021-04-15
  • Corresponding author: Qian Chen
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

车东方, 廖传鹏, 王靖生, 刘悦琤, 刘明刚, 臧冬东, 刘棋斌, 陈乾. 应用深低温保存自体颅骨治疗儿童继发性颅骨缺损的回顾性研究[J]. 中华神经创伤外科电子杂志, 2021, 07(02): 82-86.

Dongfang Che, Chuanpeng Liao, Jingsheng Wang, Yuecheng Liu, Minggang Liu, Dongdong Zang, Qibin Liu, Qian Chen. Cryopreservation of autologous cranial bone flaps for cranioplasty in children[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2021, 07(02): 82-86.

目的

研究深低温保存自体颅骨修补术应用于儿童的治疗效果及影响因素分析。

方法

回顾性分析深圳市儿童医院神经外科自2013年7月至2020年12月收治的62例深低温保存自体颅骨并行颅骨修补术患儿的临床资料，术后1周内、3、6和12个月行颅脑CT检查并随访3年，统计自体颅骨修补术的并发症并分析其相关风险因素。

结果

深低温并终末消毒保存自体颅骨术后感染率为0%，11例患儿由于颅骨吸收而采用人工材料进行二次颅骨修补，平均二次修补时间为自体颅骨修补术后18个月。自体颅骨吸收术后6个月的相关风险因素分析结果显示，年龄、骨瓣面积、术区大面积脑软化是影响自体颅骨吸收的风险因素（P<0.05）。

结论

深低温保存自体颅骨修补术治疗儿童继发性颅骨缺损效果好，感染率低，能够避免或推迟进行人工材料二次修补。低龄患儿、骨瓣面积大、大面积脑软化是自体骨瓣吸收的风险因素。

关键词: 自体颅骨瓣, 小儿颅骨成形术, 冷冻保存, 再吸收
Objective

To study the clinical effect and influencing factors of cryopreserved autologous skull bone repair in children.

Methods

The clinical data of 62 children who underwent autologous skull bone repair with cryopreservation from July 2013 to December 2020 were analyzed retrospectively. The CT examination was performed within 1 week, 3, 6, 12 months after operation, and the follow-up was conducted for 3 years. The complications of autocraniectomy were summarized and the related risk factors were analyzed.

Results

The infection rate was 0% after cryopreservation and terminal disinfection preservation autologous skull bone. Eleven cases were repaired with artificial materials due to skull bone flap resorption. The average time of second repair was 18 months after the operation. The results of risk factors analysis at 6 months after the operation showed that age, bone flap area and large area of cerebral malacia were the risk factors affecting the resorption of autologous skull bone (P<0.05).

Conclusion

Cranioplasty with cryopreserved autologous skull bone in the treatment of children with secondary skull defect has good effect and low infection rate, which can avoid or delay the secondary repair of artificial materials. The risk factors of autogenous bone flap resorption were young children, large area of bone flap and large area of encephalomalacia.

Key words: Autologous cranial bone flaps, Pediatric cranioplasty, Cryopreservation, Resorption
表1 自体颅骨修补患儿的一般资料
项目 数据[例（%）]
性别  
  男 38（61.3）
  女 24（38.7）
年龄  
  <6个月 12（19.4）
  6~11个月 6（9.7）
  1~3岁 15（24.2）
  4~6岁 17（27.4）
  7~13岁 12（19.4）
病因  
  外伤 35（56.5）
  脑血管病 9（14.5）
  脑缺血缺氧 7（11.3）
  维生素K缺乏 5（8.1）
  肿瘤 4（6.5）
  肝衰 1（1.6）
  脓毒症 1（1.6）
修补时机（去骨瓣减压术后时间）  
  22 d 2（3.2）
  1~3个月 45（72.6）
  4~7个月 15（24.2）
手术方式  
  单侧额颞顶自体颅骨修补术 33（59.7）
  双侧额颞顶自体颅骨修补术 13（22.6）
  双侧额颞顶自体颅骨修补术并侧脑室腹腔分流术 4（6.5）
  双侧额骨修补术 2（3.2）
  双侧额颞顶并枕骨自体颅骨修补术 2（3.2）
  枕骨修补术 3（4.8）
表2 各年龄段患儿在自体颅骨修补术后的3、6、12个月的吸收情况
吸收情况 <6个月 6~11个月 1~3岁 4~6岁 7~13岁
术后3个月（n=56） 9 6 13 16 12
  <25% 2 2 3 9 11
  25%~49% 3 2 5 4 1
  50%~75% 3 1 4 2 0
  >75% 1 1 1 1 0
术后6个月（n=53） 9 6 12 15 11
  <25% 1 1 2 7 9
  25%~49% 3 2 4 3 2
  50%~75% 3 1 3 3 0
  >75% 2 2 3 2 0
术后12个月（n=41） 6 4 9 13 9
  <25% 0 0 1 4 5
  25%~49% 2 1 3 4 3
  50%~75% 2 1 3 2 1
  >75% 2 2 2 3 0
图1 典型病例1自体颅骨修补术后吸收情况
图2 典型病例2自体颅骨修补术后吸收情况
表3 自体颅骨修补术后6个月颅骨吸收的相关风险因素
风险因素 骨瓣吸收率<50%（n=34） 骨瓣吸收率≥50%（n=19） χ2值 P值
性别     0.020 0.887
  男 19（55.9） 11（57.9）    
  女 15（44.1） 8（42.1）    
年龄     7.757 0.005
  <6岁 23（67.6） 19（100.0）    
  ≥6岁 11（32.4） 0（0）    
修补时机     0.211 0.646
  ≤3个月 23（67.6） 14（73.7）    
  >3个月 11（32.4） 5（26.3）    
骨瓣面积     4.444 0.035
  ≤100 cm2 21（61.8） 6（31.6）    
  >100 cm2 13（38.2） 13（68.4）    
骨瓣钻孔     0.052 0.820
  是 19（55.9） 10（52.6）    
  否 15（44.1） 9（47.4）    
术区大面积脑软化     7.078 0.008
  是 6（17.6） 10（52.6）    
  否 28（82.4） 9（47.4）    
[1]
Bowers CA, Riva-Cambrin J, Hertzler DA, et al. Risk factors and rates of bone flap resorption in pediatric patients after decompressive craniectomy for traumatic brain injury[J]. J Neurosurg Pediatr, 2013, 11(5): 526-532.
[2]
Elsawaf Y, Anetsberger S, Luzzi S, et al. Early decompressive craniectomy as management for severe traumatic brain injury in the pediatric population: a comprehensive literature review[J]. World Neurosurg, 2020, 138: 9-18.
[3]
Songara A, Gupta R, Jain N, et al. Early cranioplasty in patients with posttraumatic decompressive craniectomy and its correlation with changes in cerebral perfusion parameters and neurocognitive outcome[J]. World Neurosurg, 2016, 94: 303-308.
[4]
Corallo F, Cola MD, Buono VL, et al. Early vs late cranioplasty: what is better?[J]. Int J Neurosci, 2017, 127(8): 688-693.
[5]
Zanaty M, Chalouhi N, Starke RM, et al. Complications following cranioplasty: incidence and predictors in 348 cases[J]. J Neurosurg, 2015, 123(1): 182-188.
[6]
Feroze AH, Walmsley GG, Choudhri O, et al. Evolution of cranioplasty techniques in neurosurgery: historical review, pediatric considerations, and current trends[J]. J Neurosurg, 2015, 123(4): 1098-1107.
[7]
Canzi G, Talamonti G, Mazzoleni F, et al. Homologous banked bone grafts for the reconstruction of large cranial defects in pediatric patients[J]. J Craniofac Surg, 2018, 29(8): 2038-2042.
[8]
Phillips Z, Taylor HO, Klinge PM, et al. Piezoelectric technology for pediatric autologous cranioplasty[J]. Cleft Palate Craniofac J, 2014, 51(3): 361-364.
[9]
Beez T, Sabel M, Ahmadi SA, et al. Scanning electron microscopic surface analysis of cryoconserved skull bone after decompressive craniectomy[J]. Cell Tissue Bank, 2013, 15(1): 85-88.
[10]
Corliss B, Gooldy T, Vaziri S, et al. Complications after in vivo and ex vivo autologous bone flap storage for cranioplasty: a comparative analysis of the literature[J]. World Neurosurg, 2016, 96: 510-515.
[11]
Sahoo NK, Thakral A, Janjani L. Cranioplasty with autogenous frozen and autoclaved bone: management and treatment outcomes[J]. J Craniofac Surg, 2019, 30(7): 2069-2072.
[12]
Klieverik VM, Miller KJ, Han KS, et al. Cranioplasties following craniectomies in children-a multicenter, retrospective cohort study[J]. Childs Nerv Syst, 2019, 35(9): 1473-1480.
[13]
Rosinski CL, Chaker AN, Zakrzewski J, et al. Autologous bone cranioplasty: a retrospective comparative analysis of frozen and subcutaneous bone flap storage methods[J]. World Neurosurg, 2019, 131: e312-e320.
[14]
Abu-Ghname A, Banuelos J, Oliver JD, et al. Outcomes and complications of pediatric cranioplasty: a systematic review[J]. Plast Reconstr Surg, 2019, 144(3): 433e-443e.
[15]
Martin KD, Franz B, Kirsch M, et al. Autologous bone flap cranioplasty following decompressive craniectomy is combined with a high complication rate in pediatric traumatic brain injury patients[J]. Acta Neurochir, 2014, 156(4): 813-824.
[16]
Rocque BG, Agee BS, Thompson EM, et al. Complications following pediatric cranioplasty after decompressive craniectomy: a multicenter retrospective study[J]. J Neurosurg Pediatr, 2018, 22(3): 225-232.
[17]
Göttsche J, Fritzsche F, Kammler G, et al. A comparison between pediatric and adult patients after cranioplasty: aseptic bone resorption causes earlier revision in children[J]. J Neurol Surg A Cent Eur Neurosurg, 2020, 81(3): 227-232.
[18]
Fan MC, Wang QL, Sun P, et al. Cryopreservation of autologous cranial bone flaps for cranioplasty: a large sample retrospective study[J]. World Neurosurg, 2018, 109: e853-e859.
[1] 高翔. 冷冻保存自体颅骨行颅骨修补术56例临床分析[J]. 中华神经创伤外科电子杂志, 2018, 04(03): 148-150.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号