CAJ | 학술논문

背景:近几年来,采用计算机设计的修复体修补颅骨缺损,使颅骨重建技术得到革命性的发展.目的:利用计算机辅助设计技术进行个体化塑形钛网,观察其用于大面积额颞顶颅骨缺损修补的临床应用价值.设计、时间及地点:回顾性病例分析,于2006-01/2007-08在柳州市人民医院神经外科完成.对象:重型颅脑损伤大骨瓣减压术后额颞顶部颅骨缺损患者16例,男12例,女4例:年龄16-52岁.合并脑积水同时行V-P分流2例.缺损面积9.2 cm×11.2 cm～12.2 cm×14.6 cm.均于去骨瓣术后3～8个月行颅骨修补.方法:应用计算机辅助设计、计算机辅助制造技术和快速自动成型技术,将钛网制成个性化颅骨修复体,将已塑形好的钛网置入颅骨缺损处,用钛钉固定缺损边缘.主要观察指标:颅骨修复后塑形效果、并发症.结果:1例出现少量皮下积液,经穿刺抽液加压包扎后积液消失;钛网固定牢固,无浮动,头部正面观察对称适中,侧面观察曲度适合,无不规则凹陷,咀嚼无障碍.所有患者随访3～18个月,无感染现象发生,无修补材料外露、塌陷、松动等常见颅骨修补并发症发生.结论:应用计算机辅助设计颅骨缺损成型技术,对大面积颅骨缺损进行修复,可有效减少术后并发症,提高修复效果.
배경:근궤년래,채용계산궤설계적수복체수보로골결손,사로골중건기술득도혁명성적발전.목적:이용계산궤보조설계기술진행개체화소형태망,관찰기용우대면적액섭정로골결손수보적림상응용개치.설계、시간급지점:회고성병례분석,우2006-01/2007-08재류주시인민의원신경외과완성.대상:중형로뇌손상대골판감압술후액섭정부로골결손환자16례,남12례,녀4례:년령16-52세.합병뇌적수동시행V-P분류2례.결손면적9.2 cm×11.2 cm～12.2 cm×14.6 cm.균우거골판술후3～8개월행로골수보.방법:응용계산궤보조설계、계산궤보조제조기술화쾌속자동성형기술,장태망제성개성화로골수복체,장이소형호적태망치입로골결손처,용태정고정결손변연.주요관찰지표:로골수복후소형효과、병발증.결과:1례출현소량피하적액,경천자추액가압포찰후적액소실;태망고정뢰고,무부동,두부정면관찰대칭괄중,측면관찰곡도괄합,무불규칙요함,저작무장애.소유환자수방3～18개월,무감염현상발생,무수보재료외로、탑함、송동등상견로골수보병발증발생.결론:응용계산궤보조설계로골결손성형기술,대대면적로골결손진행수복,가유효감소술후병발증,제고수복효과.
BACKGROUND: More recently,repair of skull defect with computer-designed prosthesis contributes to the revolutionary development of skull reconstruction technique. OBJECTIVE: To individually molded titanium mesh by computer-aided design (CAD) technique,and to observe the clinical application value of the titanium mesh in the repair of large-area skull defects in the fronto- temporo-parietal lobes. DESIGN,TIME AND SETTING: A retrospective case analysis was performed at the Department of Neurosurgery,Liuzhou People's Hospital between January 2006 and August 2007.PARTICIPANTS: A total of 16 patients comprising 12 males and 4 females,aged 16-52 years,suffered from skull defects in the fronto-temporo-parietai lobes following standard large trauma craniotomy and were recruited into this stud Two of these patients were complicated by hydrocephalus and received ventriculoperitoneal shunt. Skull defect area ranged between 9. 2 cm ×11.2 cm and 12.2 cm×14.6 cm. Skull defect neoplasty was performed in all patients 3-8months following standard large trauma craniotomy. METHODS: Titanium mesh patches were individually modeled by CAD,computer-aided manufacturing (CAM) and rapid shaping techniques and implanted into skull defect region. In addition,defect edge was fastened with titanium nails. MAIN OUTCOME MEASURES: Moulding effects and complications following skull defect neoplasty. RESULTS: A small amount of subcutaneous effusion was found in one patient and disappeared after liquid extraction and pressure dressing. Titanium mesh was firmly fixed with no loosening. Patients exhibited left-right symmetry,appropriate lateral curvature,no irregular umbilication or chewing dysfunction. All patients were followed for 3-18 months postoperatively and were satisfied with good resuRs,Le.,no complications,infection,material exposure,loosening,or collapse. CONCLUSION: CAD technique used for repair of skull defects is convenient,effective,and safe. This method can. reduce postoperative complications and improve repair effects.