Moss S D, Joganic E, Manwaring K H, Beals S P
Phoenix Children's Hospital, AZ 85006, USA.
Pediatr Neurosurg. 1995;23(4):199-204; discussion 204-5. doi: 10.1159/000120959.
Surgical reconstruction of cranial deformities and synostosis is occasionally accompanied by incomplete bone growth to cover all areas of cranial vault that have been exposed in the correction. The restrictive nature of some forms of synostosis require more bone in the repair than is available using the child's natural skull for autogenous bone cranioplasty. Rib and iliac crest autografts have been used with success. These grafts must be harvested form a remote site with increased morbidity. A split-thickness skull autograft is the cranioplasty material of choice but children under the age of 6 years may lack the skull thickness needed to use this technique. Perforated demineralized bone matrix has been transplanted in 46 operations in 42 patients from 1990 to 1995 for repair of residual skull defects in children having previously undergone craniofacial repairs, for primary reconstruction of the cranial vault for patients with synostosis and for repair of skull defects resulting from trauma and skull tumor excisions. The vast majority of grafts have resulted in complete closure of the defect, providing a matrix for new bone formation. These patients are presented. Surgical techniques of cranial defect repair with perforated demineralized bone matrix are discussed.
颅骨畸形和颅缝早闭的外科重建偶尔会伴有骨生长不完全的情况，无法覆盖矫正过程中暴露的所有颅顶区域。某些形式的颅缝早闭的局限性使得修复所需的骨量比利用儿童自身颅骨进行自体颅骨成形术可获得的骨量更多。肋骨和髂嵴自体骨移植已成功应用。这些移植骨必须从远处获取，会增加发病率。分层颅骨自体骨移植是颅骨成形术的首选材料，但6岁以下儿童可能缺乏使用该技术所需的颅骨厚度。1990年至1995年期间，在42例患者的46次手术中移植了多孔脱矿骨基质，用于修复先前接受过颅面修复的儿童的残余颅骨缺损、为颅缝早闭患者进行颅顶的初次重建以及修复创伤和颅骨肿瘤切除导致的颅骨缺损。绝大多数移植都使缺损完全闭合，为新骨形成提供了基质。本文展示了这些患者情况。还讨论了使用多孔脱矿骨基质修复颅骨缺损的手术技术。
