Ewald Christian, Duenisch Pedro, Walter Jan, Götz Theresa, Witte Otto W, Kalff Rolf, Günther Albrecht
Neurosurgical Department, Jena University Hospital, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany,
Neurocrit Care. 2014 Feb;20(1):91-7. doi: 10.1007/s12028-013-9892-4.
Autologous bone flap reinsertion follows as a second surgical intervention after decompressive craniectomy in patients with malignant middle cerebral artery (MCA) infarction. In addition to surgery-related short-term complications, aseptic resorption of the reimplanted bone flap is a possible long-term problem which has not yet been sufficiently elucidated in these patients.
A total of 109 patients who had undergone decompressive hemicraniectomy for malignant MCA infarction in our institution between September 1994 and December 2011 were included in the study. Clinical and radiological findings were retrieved retrospectively. Aseptic bone necrosis was classified into two categories based on computer tomographic features.
A total of 76 patients received their own cryoconserved bone flap (mean age 54.34 ± 10.73 years; 49 males). The overall short-term complication rate was 9.2 %. Bone flap necrosis occurred in 26 patients (22.8 %) with 7 flaps showing signs of surgically relevant type II necrosis after a median time of 14 months (interquartile range [IQR] 4-22).
There is a noticeable complication rate in patients undergoing bone flap reinsertion after hemicraniectomy due to malignant MCA infarction. Aseptic bone necrosis represents a significant complication during long-term follow-up. The pathophysiological mechanisms remain unclear and more efforts should be undertaken to understand and possibly prevent this complication in these patients.
对于恶性大脑中动脉（MCA）梗死患者，自体骨瓣回植是减压性颅骨切除术后的第二步手术干预。除了与手术相关的短期并发症外，再植入骨瓣的无菌性吸收是一个可能的长期问题，在这些患者中尚未得到充分阐明。
本研究纳入了1994年9月至2011年12月期间在我院因恶性MCA梗死接受减压性半颅骨切除术的109例患者。回顾性收集临床和影像学资料。根据计算机断层扫描特征将无菌性骨坏死分为两类。
共有76例患者接受了自体冷冻保存骨瓣（平均年龄54.34±10.73岁；男性49例）。总体短期并发症发生率为9.2%。26例患者（22.8%）发生骨瓣坏死，其中7例骨瓣在中位时间14个月（四分位间距[IQR]4-22）后出现与手术相关的II型坏死迹象。
因恶性MCA梗死行半颅骨切除术后进行骨瓣回植的患者存在明显的并发症发生率。无菌性骨坏死是长期随访中的一个重要并发症。其病理生理机制尚不清楚，应进一步努力了解并可能预防这些患者的这种并发症。
