Singh Navneet, Steinbok Paul
Division of Neurosurgery, BC Children's Hospital and University of British Columbia, Vancouver, BC, Canada.
Childs Nerv Syst. 2018 Jun;34(6):1235-1239. doi: 10.1007/s00381-017-3620-x. Epub 2017 Oct 31.
Bone flap fixation after craniotomy is a standard part of neurosurgical practice. Several techniques and devices exist, though no ideal strategy has been identified. The key aims are to prevent infection and to achieve adequate cosmesis and bony fusion whilst also minimising costs and complications. Ease of use must also be considered. Fixation with sutures and bony struts in the kerf has been described in children and adults and, although the technique achieves many of the ideals of fixation, it does not seem to have been popularised. We report our experience of using the strut technique.
A retrospective review of our cranial surgery database, operative notes and follow-up records was conducted. 300 applicable craniotomies were carried out in 8 years. Struts were used in 81 cases and comments on the bony contour described in 21 follow-up records.
In nineteen, the contour was perfect. In one, there was a small bony depression; and in one, there was a small ridge in the posterior part. No repeat operations were carried out for surgery or cosmesis.
We report our results with a view to reminding the neurosurgical community of the existence of a technique that achieves all the criteria of the ideal fixation strategy.
开颅术后骨瓣固定是神经外科手术的标准环节。虽然存在多种技术和器械，但尚未确定理想的策略。关键目标是预防感染，实现良好的美观效果和骨融合，同时尽量降低成本和减少并发症。使用的便捷性也必须考虑在内。儿童和成人中均有使用缝线和骨槽内骨支柱进行固定的描述，尽管该技术实现了许多固定的理想目标，但似乎并未得到广泛应用。我们报告了使用骨支柱技术的经验。
对我们的颅脑手术数据库、手术记录和随访记录进行了回顾性分析。8年期间共进行了300例适用的开颅手术。其中81例使用了骨支柱，21份随访记录中有对骨轮廓的描述。
19例骨轮廓完美；1例有小的骨凹陷；1例后部有小的嵴。没有因手术或美观问题进行再次手术。
我们报告这些结果，旨在提醒神经外科界存在一种满足理想固定策略所有标准的技术。
