Langer Pierre, Black Cameron, Egan Padraig, Fitzpatrick Noel
Fitzpatrick Referrals, Orthopaedic and Neurology Hospital, Halfway Lane, Eashing, Godalming, GU7 2QQ, UK.
BMC Vet Res. 2018 Jun 22;14(1):199. doi: 10.1186/s12917-018-1506-0.
To date, calvarial defects in dogs have traditionally been addressed with different types of implants including bone allograft, polymethylmethacrylate and titanium mesh secured with conventional metallic fixation methods. This report describes the use of an absorbable and non absorbable novel polymer fixation method, Bonewelding® technology, in combination with titanium mesh for the repair of calvarial defects in two dogs. The clinical outcomes and comparative complication using resorbable and non-resorbable thermoplastic pins were compared.
This report of two cases documents the repair of a traumatic calvarial fracture in an adult male Greyhound and a cranioplasty following frontal bone tumor resection in an adult female Cavalier King Charles Spaniel with the use of a commercially available titanium mesh secured with an innovative thermoplastic polymer screw system (Bonewelding®). The treatment combination aimed to restore cranial structure, sinus integrity and cosmetic appearance. A mouldable titanium mesh was cut to fit the bone defect of the frontal bone and secured with either resorbable or non-resorbable polymer pins using Bonewelding® technology. Gentamycin-impregnated collagen sponge was used intraoperatively to assist with sealing of the frontal sinuses. Calvarial fracture and post-operative implant positioning were advised using computed tomography. A satisfactory restoration of skull integrity and cosmetic result was achieved, and long term clinical outcome was deemed clinically adequate with good patient quality of life. Postoperative complications including rostral mesh uplift with minor associated clinical signs were encountered when resorbable pins were used. No postoperative complications were experienced in non-resorbable pins at 7 months follow-up, by contrast mesh uplift was noted 3 weeks post-procedure in the case treated using absorbable pins.
The report demonstrates the innovative use of sonic-activated polymer pins (Bonewelding® technology) alongside titanium mesh is a suitable alternative technique for skull defect repair in dogs. The use of Bonewelding® may offer advantages in reduction of surgical time. Further, ultrasonic pin application may be less invasive than alternative metallic fixation and potentially reduces bone trauma. Polymer systems may offer enhanced mesh-bone integration when compared to traditional metallic implants. The use of polymer pins demonstrates initial potential as a fixation method in cranioplasty. Initial findings in a single case comparison indicate a possible advantage in the use of non-absorbable over the absorbable systems to circumvent complications associated with variable polymer degradation, further long term studies with higher patient numbers are required before reliable conclusions can be made.
迄今为止，犬颅骨缺损传统上采用不同类型的植入物进行处理，包括同种异体骨移植、聚甲基丙烯酸甲酯和用传统金属固定方法固定的钛网。本报告描述了一种可吸收和不可吸收的新型聚合物固定方法——骨焊接（Bonewelding®）技术，与钛网联合用于修复两只犬的颅骨缺损。比较了使用可吸收和不可吸收热塑性销钉的临床结果及相关并发症。
本报告的两个病例记录了一只成年雄性灵缇犬的外伤性颅骨骨折修复以及一只成年雌性查理士王小猎犬额骨肿瘤切除术后的颅骨成形术，使用了市售的钛网并用创新的热塑性聚合物螺钉系统（骨焊接（Bonewelding®））固定。该治疗组合旨在恢复颅骨结构、鼻窦完整性和外观。将可塑形的钛网裁剪以适配额骨的骨缺损，并用骨焊接（Bonewelding®）技术使用可吸收或不可吸收的聚合物销钉固定。术中使用庆大霉素浸渍的胶原海绵辅助封闭额窦。建议使用计算机断层扫描监测颅骨骨折及术后植入物位置。实现了颅骨完整性的满意恢复和美容效果，长期临床结果在临床上被认为是足够的，患者生活质量良好。使用可吸收销钉时遇到术后并发症，包括吻侧网片隆起及轻微相关临床体征。在7个月的随访中，使用不可吸收销钉未出现术后并发症，相比之下，使用可吸收销钉治疗的病例在术后3周出现网片隆起。
该报告表明，声激活聚合物销钉（骨焊接（Bonewelding®）技术）与钛网联合的创新应用是犬颅骨缺损修复的一种合适替代技术。使用骨焊接（Bonewelding®）可能在减少手术时间方面具有优势。此外，超声销钉应用可能比其他金属固定侵入性更小，并可能减少骨创伤。与传统金属植入物相比，聚合物系统可能提供增强的网片与骨的整合。聚合物销钉的使用显示出作为颅骨成形术中固定方法的初步潜力。单病例比较的初步结果表明，使用不可吸收系统可能比可吸收系统具有优势，以规避与聚合物降解变化相关的并发症，在得出可靠结论之前，需要对更多患者进行进一步的长期研究。
