Yokoyama Rintaro, Mikami Takeshi, Noshiro Shouhei, Miyata Kei, Toyama Kentaro, Komatsu Katsuya, Kikuchi Noriaki, Hasegawa Tadashi, Mikuni Nobuhiro
Department of Neurosurgery, Sapporo Medical University.
No Shinkei Geka. 2017 Jan;45(1):47-52. doi: 10.11477/mf.1436203448.
Aseptic bone flap resorption, a rare complication after cranioplasty following decompressive craniectomy, is more likely to develop in children. We experienced two cases of aseptic bone flap resorption and identified potential pathophysiological mechanisms through histological findings. In the first case, an 11-year-old girl underwent decompressive craniectomy due to brain swelling with contusion. An autologous bone flap was cryopreserved for four months. Twenty-five months after cranioplasty with autologous bone flap, aseptic bone flap resorption was observed, and cranioplasty was performed with ceramic bone. Most of the histological findings in this case showed mature osseous tissue, while some showed osteoclasts and new bone formation due to endochondral ossification. In the second case, a 10-year-old girl underwent frontal craniectomy and removal of contusional hematoma. Fourteen months after cranioplasty with autologous bone flap, aseptic bone flap resorption was observed, and cranioplasty was performed with ceramic bone paste. The progression of bone flap resorption was not recognized for 12 months. In these cases, new bone formation was not necessarily linked to pathological bone flap resorption. It is supposed that the balance between bone destruction and new bone formation was disrupted by unknown factors.
无菌性骨瓣吸收是减压性颅骨切除术后颅骨成形术罕见的并发症，在儿童中更易发生。我们遇到了两例无菌性骨瓣吸收病例，并通过组织学检查结果确定了潜在的病理生理机制。第一例中，一名11岁女孩因脑挫裂伤伴肿胀接受了减压性颅骨切除术。自体骨瓣被冷冻保存了四个月。在使用自体骨瓣进行颅骨成形术后25个月，观察到无菌性骨瓣吸收，随后使用陶瓷骨进行了颅骨成形术。该病例的大多数组织学检查结果显示为成熟的骨组织，而部分结果显示有破骨细胞以及由于软骨内成骨而形成的新骨。第二例中，一名10岁女孩接受了额部颅骨切除术并清除了挫伤性血肿。在使用自体骨瓣进行颅骨成形术后14个月，观察到无菌性骨瓣吸收，随后使用陶瓷骨糊进行了颅骨成形术。在12个月内未发现骨瓣吸收进展。在这些病例中，新骨形成不一定与病理性骨瓣吸收相关。推测骨破坏与新骨形成之间的平衡被未知因素打破。
