Objective To investigate the clinical application of self-cranial bone powder in one stage cranioplasty．Methods From October 1999 to December 2002,self-cranial bone powder and medical adhesive were used to repair the skull defect, for one stage cranioplasty, caused by operations on cranium in 128 casesof severe dangerous craniocerebral injury, acute intracranial hematome, sick skull and intracranial tumor．The bone growth was observed by CT or X-ray examination 3-24 months after replantation of cranioplasty．Results The decompression and cranioplasty were performed simultaneously, the time prolonged 5-10 minutes than that of routine, the appearance of repaired cranial bone was normal, without concavity and convexity. After 12 months of operation, the replanted bone merged with the normal bone completely, with normal appearance. The operation successful rate was 96.1%(123/125) without any complication. Only fivecases were not better in growing because of less bone powder, but withoutcerebral pulse and defective syndrome. All the cases did not need secondary cranioplasty．Conclusion The effect of cranioplasty with self-cranial bone powder effect is good in taking shape. This new method can avoid the traditional secondary cranioplasty for skull defect and complications．
摘要:目的:进行深低温贮存回植自体颅骨瓣的临床应用效果研究。方法:将74例患者术后骨瓣深低温(零下80℃)贮存,2～12月后予以原位回植,术中取骨标本病检,随诊1～36月。结果:74例中72例伤口Ⅰ期愈合,颅骨复位良好。病检示回植骨有正常骨细胞,与新鲜颅骨对照无骨母细胞。2例患者回植骨吸收明显,失去支撑作用而再次行修补钛网,2例感染,余下70例患者2～4月后骨缝不同程度增宽1～2 mm,6月后骨缝不再增宽,12～36月后骨缝部分变窄,达骨性愈合,而颅骨钻孔处及颞下骨缝较宽区未见骨性结构,为纤维疤痕愈合。结论:深低温贮存的自体颅骨部分骨细胞能长时间存活,回植后无免疫排异性。回植手术简便,患者容易接受,临床应用效果较好。
OBJECTIVE: To determine whether culture expanded bone marrow derived mesenchymal stem cells (MSCs) in combination with beta-tricalcium phosphate(beta-TCP) can repair critical cranial defects in New Zealand rabbits. METHODS: In group A(n = 20), MSCs from homogeneous rabbits were isolated and expanded in vitro and then implanted onto the pre-molded porous beta-TCP. The MSCs-beta-TCP complexes were implanted into rabbit critical cranial defects. In group B (n = 10), The defects were repaired with beta-TCP only. In group C(n = 4), the defects were left un-repaired. Samples were extracted 6 and 12 weeks after operation for histological, histochemical and immunohistochemical analysis. RESULTS: In group A, bone-like tissue formation could be seen on the surface of the implants. Microscopic analysis demonstrated certain degradation of beta-TCP and extensive new bone filling in rich extracellular matrix after 6 weeks. The cells were stained positively for type I collagen. After 12 weeks, the bioceramics had almost completely degraded and abundant bone formation could be seen in the whole defects. In group B, marginal bone ingrowth was observed after 6 weeks and the number of osteoblasts increased significantly after 12 weeks. However, no new bone formation could be detected in the middle of the material. In group C, only a small quantity of new bone formation was found along the margin of defects. CONCLUSION: Transplantation of MSCs with beta-TCP can serve as an example of a cell-based treatment for bone regeneration in skeletal defects.
Objective To observe the relationship of osteoblasts, endothelial cells and ceramic scaffold during reconstruction of rat critical size calvarial defects with tissue engineering technique under transmission electron microscope. Methods Fourteen male adult Sprague Dawley rats were divided randomly into experimental and control groups. Bone marrow was obtained from left femurs and tibias of all rats. In experimental group, respective autogenous osteoblasts derived from bone marrow stromal cells(MSCs) different iated and proliferated in vitro and then were seeded and subcultured on porous calcium phosphate ceramics. The cell-ceramic compounds were used to repair critical-sized (8 mm diameter) calvarial defects in the corresponding rats. In control group, the ceramic without autogenous osteoblosts was used. One rat of each group was sacrificed postoperatively in the 4th, 8th, 12th, 24th, 28th weeks respectively and involved samples were removed to make decalcified ultrath in sections and observed under transmissionelectron microscope. Results Osteoblasts or osteoblast-like cells always located next to sprouting capillaries and the relationship between osteoblasts and endothelial cells was relevant in experimental group. There was a calcium depositzone distributed along the boundary of newly formed bone and the remnants of decalcified ceramic, which meant osseointegration between the ceramic and newly formed bone. The above changes did not appear in control group simultaneously.Conclusion The nanometer scale structure of ceramic scaffold benefits to angiogenesis, osteogenesis and extracellular matrix formation in repair bone defects with tissue engineering technique.
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 cm² underwent skull repair with pMC (pMC group), 45 patients with defects ≥3 cm² and aged ≥5 years underwent skull repair with cMC (cMC group), and 2 patients with defects ≥3 cm² 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 (1 123.74±93.64) HU and (1 128.14±92.57) HU, respectively, with no significant difference (t=0.261, P=0.795). Conclusion MC exhibits good biocompatibility and osteogenic induction ability in skull defect repair. pMC is suitable for repairing small defects, cMC is suitable for repairing large defects, and bMC is suitable for repairing pediatric skull defects.
ObjectiveTo investigate the technique and the effectiveness of digital three-dimensional (3-D) titanium mesh in repairing skull defect under the temporalis and reconstructing temporal muscle attachment points. MethodsBetween January 2009 and December 2012, 58 patients with skull defect after decompressive craniectomy at the frontal temporal region were treated. Of 58 patients, 33 were male and 25 were female, aged 17-62 years (mean, 36.2 years). The disease duration was 15 weeks to 25 months (mean, 5.8 months). The size of skull defect ranged from 8 cm×6 cm to 15 cm×12 cm. The patients underwent skull impairment patch surgery with digital 3-D titanium mesh and reconstruction of the temporal muscle attachment points at titanium mesh temporal corresponding position. ResultsThe operation time was 60-100 minutes (mean, 87 minutes). After operation, 2 cases had slight red swelling with little exudation at skin incision margin, which was cured after symptomatic treatment; 2 cases had symptom of headache, which disappeared after incision healing; primary healing of incision was obtained in the other patients. Fifty-eight patients were followed up 6-24 months (mean, 16 months). The patients were satisfied with shaping, and had no chewing pain. Head CT after operation showed good fixation of titanium mesh and titanium nail, and satisfactory skull shape symmetry; no postoperative complication of subcutaneous effusion, intracranial bleeding, titanium mesh loosening, or titanium mesh exposure occurred. ConclusionThe surgery technique of digital 3-D titanium mesh to repair skull defect in frontal temporal region and to reconstruct temporal muscle attachment points at the corresponding position of titanium mesh, basically can obtain anatomical reduction of the skull, frontal temporal, and each layer of scalp. It has the advantages of less complication, less titanium nail, and satisfactory shape.
Good results were achieved in Ⅰ8 cases of cranioplasty in which a new meterial of medical polymer had been used. The properties of the material and the operation method are also described in this paper, The advantages of the new matiral become more obvious, in comparison with other methods which are usually used in cranioplasty.
Based on the dye injection investigation, the territory of blood supply through the superficial temperal artery system was defined. Vascularized grafts, composed of temperal-parietal fascia, periosteum and outer-table of calvarial bone, can be transferred by microvascular anastomosis or transposed to repair full-thickness defects of skull bone was demonstrated. Six of such cases following electrical burn were successfully treated. The average size of skull bone defects was 50cm2. The largest one among them was 80cm2.