Maclellan Reid A, Hassanein Aladdin H, Kurek Kyle C, Mulliken John B, Rogers Gary F, Greene Arin K
From the Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA.
Ann Plast Surg. 2016 Apr;76(4):438-41. doi: 10.1097/SAP.0000000000000396.
Inlay cranioplasty in children is challenging because autologous bone is limited. Cranial particulate bone graft effectively closes defects when placed over normal dura. The purpose of this study was to determine if particulate bone graft will ossify when used for secondary cranioplasty over scarred dura.
A 17 × 17-mm critical-sized defect was made in the parietal bone of 16 rabbits. Four animals had no implant (group 1). Twelve animals had the defect remade 16 weeks postoperatively, which was managed in 2 ways: group 2 (no implant; n = 6) and group 4 (particulate bone graft; n = 6). Particulate graft was obtained using a brace and bit from the frontal bone. Computed tomography was used to determine the area of ossification and thickness of the healed graft. Eight animals previously managed with particulate bone graft over normal dura were used as an additional control (group 3).
Critical-sized defects filled with particulate bone graft over scarred dura (group 4) exhibited superior healing of the area (83.8%; range, 73.0%-90.6%) compared to control defects over normal dura (group 1: 62.9%; range, 56.5%-73.4%) or scarred dura (group 2: 56.9%; range, 40.0%-68.3%) (P = 0.0004). Particulate bone on scarred dura exhibited less ossified area (P = 0.002), and thinner bone (0.95 mm, range, 0.71-1.32 mm) compared to defects in which graft was placed over normal dura (group 3: area, 99.2%; range, 96.8%-100%; thickness, 1.9 mm, range; 1.1-3.1 mm) (P = 0.04).
Particulate bone graft ossifies inlay cranial defects over scarred dura although inferior to placement over normal dura. Clinically, particulate bone graft may be used for secondary inlay cranioplasty.
儿童镶嵌式颅骨成形术具有挑战性，因为自体骨有限。颅骨颗粒骨移植置于正常硬脑膜上时可有效闭合缺损。本研究的目的是确定颗粒骨移植用于瘢痕化硬脑膜上的二期颅骨成形术时是否会骨化。
在16只兔子的顶骨上制造一个17×17毫米的临界尺寸缺损。4只动物不植入任何东西（第1组）。12只动物在术后16周重新制造缺损，采用两种方式处理：第2组（不植入；n = 6）和第4组（颗粒骨移植；n = 6）。颗粒移植物取自额骨，使用手摇钻和钻头获取。采用计算机断层扫描确定骨化面积和愈合移植物的厚度。另外8只先前在正常硬脑膜上使用颗粒骨移植处理的动物用作额外对照（第3组）。
与正常硬脑膜上的对照缺损（第1组：62.9%；范围56.5% - 73.4%）或瘢痕化硬脑膜上的对照缺损（第2组：56.9%；范围40.0% - 68.3%）相比，瘢痕化硬脑膜上填充颗粒骨移植的临界尺寸缺损（第4组）显示出更好的区域愈合（83.8%；范围73.0% - 90.6%）（P = 0.0004）。与移植物置于正常硬脑膜上的缺损（第3组：面积99.2%；范围96.8% - 100%；厚度1.9毫米，范围1.1 - 3.1毫米）相比，瘢痕化硬脑膜上的颗粒骨骨化面积较小（P = 0.002），且骨较薄（0.95毫米，范围0.71 - 1.32毫米）（P = 0.04）。
颗粒骨移植可使瘢痕化硬脑膜上的镶嵌式颅骨缺损骨化，尽管不如置于正常硬脑膜上。临床上，颗粒骨移植可用于二期镶嵌式颅骨成形术。
