Cryopreservation of autologous cranial bone flaps for cranioplasty in children

doi:10.3877/cma.j.issn.2095-9141.2021.02.004

Abstract

Abstract:

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

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.

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Figures/Tables 5

References 18

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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）

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）

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

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

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）

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