Garst Jonathan R, Lara-Reyna Jacques, Elliott Willie, Tsung Andrew J
Department of Neurosurgery, University of Illinois College of Medicine at Peoria, OSF HealthCare Illinois Neurological Institute, Peoria, Illinois, USA.
Department of Neurosurgery, University of Illinois College of Medicine at Peoria, OSF HealthCare Illinois Neurological Institute, Peoria, Illinois, USA.
World Neurosurg. 2023 May;173:e62-e65. doi: 10.1016/j.wneu.2023.01.103. Epub 2023 Feb 3.
Historically, depressed skull fractures that warranted surgery were treated in 2 stages: the first stage involved debridement and craniectomy, followed by the second stage of delayed cranioplasty. More recently, single-stage autologous cranioplasty has been proven to be safe. However, there is a paucity of literature regarding single-stage titanium mesh cranioplasty when autologous repair is not possible.
A retrospective review identified 22 patients who underwent single-stage titanium mesh cranioplasty for the acute treatment of comminuted depressed skull fractures. Fracture location, fracture etiology, timing of surgery, neurologic complications, infection, and cosmetic deformity were recorded. Average follow-up was 9 months.
The mean age of the patients was 34 years (range: 3-77); 83% were male. Seventeen (77%) involved the frontal bone, with 7 (32%) involving the frontal sinus. Eighteen (82%) had open defects at presentation. Sixteen (73%) were neurologically normal. Average time from presentation to repair was 11 hours (range: 1-28 hours). There were no neurologic worsening, seizures, or infections postoperatively. Antibiotic prophylaxis was prescribed in 13 cases (57%). One patient required revision surgery for persistent cosmetic deformity.
Autologous cranioplasty for depressed skull fractures is not always possible especially in cases of significant comminution. From our case series, single-stage titanium mesh cranioplasty appears to be a safe option.
从历史上看，需要手术治疗的凹陷性颅骨骨折分两个阶段进行治疗：第一阶段包括清创和颅骨切除术，随后是延迟颅骨成形术的第二阶段。最近，一期自体颅骨成形术已被证明是安全的。然而，关于在无法进行自体修复时一期钛网颅骨成形术的文献较少。
一项回顾性研究确定了22例因粉碎性凹陷性颅骨骨折的急性治疗而接受一期钛网颅骨成形术的患者。记录骨折部位、骨折病因、手术时间、神经并发症、感染和美容畸形情况。平均随访时间为9个月。
患者的平均年龄为34岁（范围：3 - 77岁）；83%为男性。17例（77%）累及额骨，7例（32%）累及额窦。18例（82%）在就诊时存在开放性缺损。16例（73%）神经功能正常。从就诊到修复的平均时间为11小时（范围：1 - 28小时）。术后无神经功能恶化、癫痫发作或感染。13例（57%）患者接受了抗生素预防治疗。1例患者因持续性美容畸形需要进行翻修手术。
凹陷性颅骨骨折的自体颅骨成形术并非总是可行，特别是在粉碎严重的情况下。从我们的病例系列来看，一期钛网颅骨成形术似乎是一种安全的选择。
