Shelef Ilan, Golan Haim, Merkin Vladimir, Melamed Israel, Benifla Mony
Diagnostic Imaging Department, Soroka University Medical Center, POB-151, Beer Sheva 84101, Israel.
Nuclear Medicine, Assaf Harofe Medical Center, Zerifin, Israel.
J Clin Neurosci. 2016 Sep;31:63-6. doi: 10.1016/j.jocn.2015.11.031. Epub 2016 Apr 8.
There are currently two accepted neurosurgical methods to perform a bony flap. In an osteoplastic flap, the flap is attached to surrounding muscle. In a free flap, the flap is not attached to adjacent tissues. The former is less common due to its complexity and the extensive time required for the surgery; yet the rate of infection is significantly lower, a clear explanation for which is unknown. The objective of this study was to test the hypothesis that the osteoplastic flap acts as a live implant that resumes its blood flow and metabolic activity; contrasting with the free flap, which does not have sufficient blood flow, and therefore acts as a foreign body. Seven patients who underwent craniotomy with osteoplastic flaps and five with free flaps had planar bone and single photon emission computed tomography (SPECT) scans of the skull at 3-7days postoperative, after injection of the radioisotope, 99m-technetium-methylene diphosphonate (99m-Tc-MDP). We compared radioactive uptake as a measure of metabolic activity between osteoplastic and free flaps. Mean normalized radioactive uptakes in the centers of the flaps, calculated as the ratios of uptakes in the flap centers to uptakes in normal contralateral bone, were [mean: 1.7 (SD: 0.8)] and [0.6 (0.1)] for the osteoplastic and free flap groups respectively and were [2.4 (0.8)] and [1.3 (0.4)] in the borders of the flaps. Our analyses suggest that in craniotomy, the use of an osteoplastic flap, in contrast to free flap, retains bone viability.
目前有两种被认可的进行骨瓣手术的神经外科方法。在塑形骨瓣手术中，骨瓣与周围肌肉相连。在游离骨瓣手术中，骨瓣不与相邻组织相连。前者由于其复杂性和手术所需的较长时间而较少见；然而其感染率显著较低，对此尚无明确解释。本研究的目的是检验以下假设：塑形骨瓣作为一种有活性的植入物，能恢复其血流和代谢活动；与之形成对比的是，游离骨瓣没有足够的血流，因此起到异物的作用。7例行塑形骨瓣开颅手术的患者和5例行游离骨瓣手术的患者在术后3 - 7天注射放射性同位素99m - 锝 - 亚甲基二膦酸盐（99m - Tc - MDP）后，进行了颅骨的平面骨和单光子发射计算机断层扫描（SPECT）。我们比较了塑形骨瓣和游离骨瓣之间作为代谢活动指标的放射性摄取情况。以骨瓣中心摄取量与对侧正常骨摄取量之比计算的骨瓣中心平均标准化放射性摄取量，塑形骨瓣组和游离骨瓣组分别为[均值：1.7（标准差：0.8）]和[0.6（0.1）]，在骨瓣边缘分别为[2.4（0.8）]和[1.3（0.4）]。我们的分析表明，在开颅手术中，与游离骨瓣相比，使用塑形骨瓣能保持骨的活力。
