Vitanovics Dusán, Major Ottó, Lovas László, Banczerowski Péter
Ideggyogy Sz. 2014 Nov 30;67(11-12):390-6.
The majority of cranial defects are results of surgical intervention. The defect must be covered within resonable period of time usually after 4-6 week given the fact that the replacement of bone improve the brain circulation. Number of surgical techniques and materials are available to perform cranioplasty. Due to favorable properties we chosed ultra high molecular weight polyethylene as material. In this paper the authors show a procedure which allows tailored artificial bone replacement using state of art medical and engineering techniques.
between 2004 and 2012, 19 patients were operated on cranial bone defect and a total of 22 3D custom-designed implants were implanted. The average age of patients was 35.4 years. In 12 patients we performed primary cranioplasty, while seven patients had the replacement at least once. Later the implants had to be removed due to infection or other causes (bone necrosis, fracture). All patients had native and bone-windowed 1 mm resolution CT. The 3D design was made using the original CT images and with design program. Computer controlled lathe was used to prepare a precise-fitting model. During surgery, the defect was exposed and the implant was fixed to normal bone using mini titanium plates and screws. All of our patients had control CT at 3, 6 and 12 months after surgery and at the same time neurological examination.
Twenty-one polyethylene and one titanium implants were inserted. The average follow-up of the patients was 21.5 months, ranged from two to 96 months. We follow 12 patients (63.15%) more than one year. No intraoperative implant modifications had to be made. Each of the 22 implant exactly matched the bone defect proved by CT scan. No one of our patients reported aesthetic problems and we did not notice any kind of aesthetic complication. We had short term complication in three cases due to cranioplasty, subdural, epidural haemorrhage and skin defect.
Polyethylene is in all respects suitable for primary and secondary cranioplasty. Combined with 3D CAD- CAM method excellent aesthetic and functional result was achieved. In our study no case of infection occured. Proper preoperative preparation is important.
大多数颅骨缺损是手术干预的结果。鉴于骨替代可改善脑循环，缺损通常必须在4至6周的合理时间内得到修复。有多种手术技术和材料可用于颅骨成形术。由于具有良好的性能，我们选择超高分子量聚乙烯作为材料。在本文中，作者展示了一种使用先进的医学和工程技术进行定制人工骨替代的方法。
2004年至2012年期间，对19例颅骨缺损患者进行了手术，共植入了22个3D定制设计的植入物。患者的平均年龄为35.4岁。12例患者进行了一期颅骨成形术，7例患者至少进行了一次置换。后来，由于感染或其他原因（骨坏死、骨折），植入物不得不被取出。所有患者均进行了1毫米分辨率的原生和骨窗CT扫描。使用原始CT图像和设计程序进行3D设计。使用计算机控制车床制备精确适配的模型。手术过程中，暴露缺损部位，使用微型钛板和螺钉将植入物固定在正常骨上。所有患者在术后3、6和12个月进行了对照CT检查，并同时进行了神经学检查。
共插入21个聚乙烯植入物和1个钛植入物。患者的平均随访时间为21.5个月，范围为2至96个月。我们对12例患者（63.15%）进行了超过一年的随访。术中无需对植入物进行修改。CT扫描证明，22个植入物中的每一个都与骨缺损完全匹配。我们的患者中没有人报告美学问题，我们也没有注意到任何美学并发症。由于颅骨成形术，有3例患者出现了短期并发症，包括硬膜下、硬膜外出血和皮肤缺损。
聚乙烯在各方面都适用于一期和二期颅骨成形术。结合3D CAD-CAM方法，可获得优异的美学和功能效果。在我们的研究中，未发生感染病例。适当的术前准备很重要。
