Shermak M A, Wong L, Inoue N, Crain B J, Im M J, Chao E Y, Manson P N
Johns Hopkins Hospital, Department of Orthopedic Surgery, Baltimore, MD, USA.
Plast Reconstr Surg. 1998 Aug;102(2):309-18. doi: 10.1097/00006534-199808000-00003.
Butyl-2-cyanoacrylate is an easily applied, biocompatible, bioresorbable polymer glue that provides an alternative to conventional rigid fixation techniques. Our aim was to determine if cyanoacrylate fixation of the bone flap in a rabbit craniotomy model provides the healing and strength afforded by plate and screw fixation. We also investigated the inflammatory responses of adjacent tissues including the scalp, cranium, and brain. A unilateral parietal bone flap was elevated in 33 adult New Zealand rabbits. The bone was fixed in position with cyanoacrylate (n = 13), fixed with a microplate and screws (n = 14), or was replaced without fixation (sham-control, n = 6). Normal scar formation and no residual polymer were found in scalp specimens. Neuropathologic analysis identified the presence of residual polymer on the surface of 2 of the 13 rabbit brains. Histopathologic analysis of the bone flap-to-skull interface revealed no difference in the degree but rather in the quality of inflammation and healing between the plate and screw and polymer fixation groups. Microdensitometric analysis of the bone gap revealed nearly equivalent bone density in the cyanoacrylate and plated groups, tending to less density in the sham group (p = 0.11 and 0.09, respectively). An additional study focusing on neurotoxicity was performed in 20 adult rabbits with 3-week and 11-week recovery periods and similarly found the absence of a marked inflammatory response to the polymer. In conclusion, bone healing and soft-tissue inflammation were comparable between cyanoacrylate and plate and screw fixation groups. Although butyl-2-cyanoacrylate glue fixation may provide a reasonable alternative to hardware fixation, further investigations are necessary to identify its ideal utilization.
氰基丙烯酸正丁酯是一种易于应用、具有生物相容性和生物可吸收性的聚合物胶水,为传统的刚性固定技术提供了一种替代方法。我们的目的是确定在兔开颅模型中使用氰基丙烯酸酯固定骨瓣是否能提供钢板和螺钉固定所带来的愈合效果和强度。我们还研究了包括头皮、颅骨和大脑在内的相邻组织的炎症反应。在33只成年新西兰兔中掀起单侧顶骨瓣。用氰基丙烯酸酯固定骨瓣(n = 13),用微型钢板和螺钉固定(n = 14),或不进行固定直接放回(假手术对照组,n = 6)。在头皮标本中发现正常的瘢痕形成且无残留聚合物。神经病理学分析发现13只兔脑中有2只脑表面存在残留聚合物。对骨瓣与颅骨界面的组织病理学分析显示,钢板和螺钉固定组与聚合物固定组在炎症和愈合程度上无差异,但在质量上有差异。对骨间隙的显微密度分析显示,氰基丙烯酸酯固定组和钢板固定组的骨密度几乎相当,假手术组的骨密度倾向于更低(p值分别为0.11和0.09)。在另外20只成年兔中进行了一项关注神经毒性的研究,恢复期分别为3周和11周,同样发现对该聚合物没有明显的炎症反应。总之,氰基丙烯酸酯固定组与钢板和螺钉固定组在骨愈合和软组织炎症方面相当。虽然氰基丙烯酸正丁酯胶水固定可能为硬件固定提供一种合理的替代方法,但仍需要进一步研究以确定其理想的应用方式。