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Objective@#To evaluate the bone repair effect of 3D-printed magnesium (Mg)-loaded polycaprolactone (PCL) scaffolds in a rat skull defect model.@*Methods@#PCL scaffolds mixed with Mg microparticles were prepared by using 3D printing technology, as were pure PCL scaffolds. The surface morphologies of the two scaffolds were observed by scanning electron microscopy (SEM), and the surface elemental composition was analyzed via energy dispersive spectroscopy (EDS). The physical properties of the scaffolds were characterized through contact angle measurements and an electronic universal testing machine. This study has been reviewed and approved by the Ethics Committee. A critical size defect model was established in the skull of 15 Sprague-Dawley (SD) rats, which were divided into the PCL group, PCL-Mg group, and untreated group, with 5 rats in each group. Micro-CT scanning was performed to detect and analyze skull defect healing at 4 and 8 weeks after surgery, and samples from the skull defect area and major organs of the rats were obtained for histological staining at 8 weeks after surgery.@*Results@#The scaffolds had a pore size of (480 ± 25) μm, a fiber diameter of (300 ± 25) μm, and a porosity of approximately 66%. The PCL-Mg scaffolds contained 1.0 At% Mg, indicating successful incorporation of Mg microparticles. The contact angle of the PCL-Mg scaffolds was 68.97° ± 1.39°, indicating improved wettability compared to that of pure PCL scaffolds. Additionally, compared with that of pure PCL scaffolds, the compressive modulus of the PCL-Mg scaffolds was (57.37 ± 8.33) MPa, demonstrating enhanced strength. The PCL-Mg group exhibited the best bone formation behavior in the skull defect area compared with the control group and PCL group at 4 and 8 weeks after surgery. Moreover, quantitative parameters, such as bone volume (BV), bone volume/total volume (BV/TV), bone surface (BS), bone surface/total volume (BS/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N) and bone mineral density (BMD), of skull defects were better than those in the other groups, indicating the best bone regeneration effect. H&E, Goldner, and VG staining revealed more mineralized new bone formation in the PCL-Mg group than in the other groups, and H&E staining of the major organs revealed good biosafety of the material.@*Conclusion@#PCL-Mg scaffolds can promote the repair of bone defects and have clinical potential as a new scaffold material for the repair of maxillofacial bone defects.
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BACKGROUND: Hydroxyapatite-geltin composite has good biocompatibility and osteoinductivity, and can used be as tissue engineering scaffold to repair bone defects. OBJECTIVE: To observe the effect of three-dimensional (3D) printed hydroxyapatite/gelatin scaffold combined with bone marrow mesenchymal stem cells and umbilical vein endothelial cells in repairing rabbit skull defects. METHODS: Nine male New Zealand white rabbits were taken to establish a skull defect model with a diameter of approximately 0.8 cm, and randomly divided into three groups: blank group: no any treatment; control group: only 3D printed hydroxyapatite-geltin scaffold; experimental group: 3D printed hydroxyapatitegeltin scaffold and bone marrow mesenchymal stem cells and bone marrow mesenchymal stem cells complex group, with three rabbits in each group. At 8 weeks after the operation, CT scan of the skull pyramid beam and histological observation of the skull defect were performed on the white rabbits of each group. Animal experiments were approved by the Ethics Committee of Jining Medical College. RESULTS AND CONCLUSION: (1) CT scan of pyramidal tract: Blank group showed obvious bone defects, and the defect area was slightly radiopaque with the edges of the surrounding normal bone tissue. Control group showed some new bone formation, which was discontinuous and inconsistent with the surrounding bone tissue. Experimental group showed that the new bone tissue was linear and continuous; the thickness was thin; and the defect area merged with the adjacent bone tissue edge. (2) Histological observation: Hematoxylin-eosin staining and Masson trichrome staining showed that fibrous connective tissue formation and a small amount of free bone cells were seen in the defect area of the blank group. A small amount of bone formation was seen in the control group. Bone matrix was deposited at the edge of the material, replacing the material to form small bone trabeculae. The material space of the experimental group was gradually replaced by new bone, and the defect area was filled with new bone and trabecular bone structure-like tissue. (3) The results show that the 3D bionic printing hydroxyapatite-geltin scaffold combined with bone marrow mesenchymal stem cells and bone marrow mesenchymal stem cells can effectively promote the growth of bone tissue and accelerate the repair of bone defects.
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Objective To investigate the effects of three-dimensional titanium mesh repair on cerebral perfusion,intracranial pressure and nerve function after decompression with bone flap.Methods From October 2015 to October 2018,132 hypertensive cerebral hemorrhage patients of bone disc decompression in the Fifth People's Hospital of Jinan were selected and divided into observation group (66 cases) and control group(66 cases) by double blind random method.The observation group received three-dimensional titanium mesh repair at 24 ～ 42 d after bone disc decompression surgery.The control group received three-dimensional titanium mesh repair at 90 ～ 150 d(3 ～ 5 months) after surgery.The changes of operation,cerebral perfusion,intracranial pressure and nerve function were compared between the two groups.Results The operative time,blood loss and free time of the flap in the observation group were (92.5 ± 12.4) min,(354.3 ± 17.5) mL and (13.2 ± 3.1) min,respectively,which were shorter or less than those in the control group [(142.8 ± 15.3) min,(518.3 ± 22.3) mL and (38.3 ± 4.3) min],the differences between the two groups were statistically significant (t=4.745,6.831,4.963,all P ＜ 0.05).After treatment,the abnormal indices of intracranial pressure and cerebral perfusion in the observation group were (0.1 ±0.0) and(0.2 ± 0.1),respectively,which were lower than those in the control group [(0.2 ± 0.1),(0.3 ± 0.1)] (t =3.657,2.579,all P ＜0.05).There were statistically significant differences in neurological deficit scores between the two groups at different time points(all P ＜0.05).The incidence of treatment complications in the observation group was 10.94％ (7/64),which was significantly lower than that in the control group [38.7％ (24/62)] (x2 =14.094,P ＜ 0.05).Conclusion Three-dimensional titanium mesh repair is helpful to shorten the operation time,restore the intracranial pressure on the affected side,improve the abnormal cerebral perfusion,and reduce the neurological damage in patients with hypertensive cerebral hemorrhage.
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Objective To explore the therapeutic effect of subcutaneous negative pressure drainage and absorbable suture in preventing postoperative complications of cranioplasty.Methods The clinical data of 175 cases of skull defect admitted and treated in Department of Neurosurgeryof the Affiliated Hospital of Binzhou Medical University from January 2012 to February 2018 were retrospectively analyzed.According to the different intraoperative treatment methods,97 cases were treated with thread suture to the galea aponeurotica combined with general drainage (the general drainage group),and 78 cases were treated with absorbable suture to the galea aponeurotica combined with negative pressure drainage(the negative pressure drainage group).The galea aponeurotica were sutured intermittently with both silk thread and absorbable suture,and the drainage tube was placed outside the metal titanium plate under the skin,and removed after 48-72 hours.The postoperative complications of the two groups were compared.Results The incidence rates of subcutaneous hemorrhage,knotting reaction,infection of incision in the negative pressure drainage group were 1.3％ (1/78),0.0％ (0/78),and 0.0％ (0/78),respectively,which were significantly lower than those in the average drainage group [11.3％ (11/97),20.6％ (20/97),7.2％ (7/97)],the differences were statistically significant (x2 =6.85,18.16,4.13,all P ＜ 0.05).Conclusion The application of absorbable suture suturing galea aponeurotica and subcutaneous negative pressure drainage in skull repair can significantly reduce and prevent postoperative complications of cranioplasty.
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Objective@#To explore the therapeutic effect of subcutaneous negative pressure drainage and absorbable suture in preventing postoperative complications of cranioplasty.@*Methods@#The clinical data of 175 cases of skull defect admitted and treated in Department of Neurosurgeryof the Affiliated Hospital of Binzhou Medical University from January 2012 to February 2018 were retrospectively analyzed.According to the different intraoperative treatment methods, 97 cases were treated with thread suture to the galea aponeurotica combined with general drainage(the general drainage group), and 78 cases were treated with absorbable suture to the galea aponeurotica combined with negative pressure drainage(the negative pressure drainage group). The galea aponeurotica were sutured intermittently with both silk thread and absorbable suture, and the drainage tube was placed outside the metal titanium plate under the skin, and removed after 48-72 hours.The postoperative complications of the two groups were compared.@*Results@#The incidence rates of subcutaneous hemorrhage, knotting reaction, infection of incision in the negative pressure drainage group were 1.3%(1/78), 0.0%(0/78), and 0.0%(0/78), respectively, which were significantly lower than those in the average drainage group[11.3%(11/97), 20.6%(20/97), 7.2%(7/97)], the differences were statistically significant(χ2=6.85, 18.16, 4.13, all P<0.05).@*Conclusion@#The application of absorbable suture suturing galea aponeurotica and subcutaneous negative pressure drainage in skull repair can significantly reduce and prevent postoperative complications of cranioplasty.
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Objective To evaluate the clinical efficacy of ventricle -peritoneal or ventricle-atrial shunt in the treatment of skull defect with craniocerebral trauma combined with hydrocephalus in the same period. Methods Sixty-four patients with skull defect after craniocerebral trauma combined with hydrocephalus were randomly divided into observation group (n=32) and control group (n=32) The ventricle-peritoneal or ventricle-atrial shunt and skull repair were conducted simultaneously following surgical operation in observation group whereas ventricle-peritoneal or ventricle-atrial shunt and the skull defect were performed within 3 months and after 3 months following operation, respectively. The hydrocephalus symptoms, prognosis after three months ,clinical outcomes and the postoperative complications were evaluated. Results There was no significant difference in hydrocephalus symptoms between the observation group and control group (χ2=0.005,P>0.05). The GCS score, GOS score and neurological function score after three months were better than those before the treatment in these two groups (P<0.05). These functional parameters were significantly better in the observation group than in control group (P<0.05). The good rate in three months was significantly higher in the observation group than in control group (59.38％vs 31.25％,χ2=7.23, P<0.05). The incidence of complication was 6.25％(2/32) in the observation group, which was significantly lower than that in the control group (31.25％, 10/32) (χ2=7.13, P<0.05).Conclusion Cranioplasty combined with shunt in the treatment of skull defect complicated with craniocerebral trauma-associated hydrocephalus has low postoperative complications, good clinical prognosis and reliable efficacy, which is worthy of clinical application.
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Objective To study on the procedure, safety and effectiveness of polyetheretherketone (PEEK) implant applied to cranioplasty of skull defect. Methods A total of 11 cases (10 male, 1 female) of unilateral skull defect, more than 6 months post operation, were included in this study. PEEK implant was custom-made by three-dimensional numerically controlled processing depended on the data obtained from 1 mm-slice CT scan before cranioplasty individually. Autoclaved implants were applied to cranioplastic surgeries under general anesthesia. Findings of imaging examination and vital signs were compared before and after operation. Vital sign changes and circumstances during procedure were noted, and following-up reviews were performed on 2-week, 3-month and 1 year after operation respectively. Results Wounds healing were uneventful in 11 cases, no postoperative paresthesia presented. Surgical complications including temporary subcutaneous exudates were cleared up by puncture and aspiration in 5 cases, subcutaneous hematoma duo to drainage removal in 1 case, of which an emergency evacuation was performed and the implant was still with instant incision closure and then smooth recovery eventually. No significant abnormal fluctuation of laboratory examination was reported, moreover no artifact interference was found on postoperative CT scan or MR image. The subjective feelings and external sensory effects are satisfactory in patients. No emerging dysfunction of central nervous system or other organs was found, and no long-term complication was appeared. Conclusion It is feasible and safe to apply PEEK implant to cranioplasty without additional operative difficulty. This kind of material is an ideal alternative for repairing skull defect to patients with good financial condition and specific demands for postoperative status especially.
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Objective To evaluate the osteogenesis of rabbit allogeneic tooth derived bone graft material by histological detection ,so as to provide quality and cheap repair materials for the repair of bone defects in dental implants. Methods The bone graft materials were prepared using rab?bits allogeneic extracted teeth. A total of 28 adult Japanese healthy rabbits were selected to establish the cranial defect model with three 8 mm diam?eter holes. The allogenic tooth derived bone graft material were implanted into the experimental group. The artificial bone repair material was used as the control group,and the control group did not receive any implantion. Tetracycline labeling was performed after operation,the specimens were taken at 4,8 and 12 weeks after operation,and then the gross observation,X?ray examination,preparation of hard tissue sections,and HE staining were carried out. Results Histological analysis at 4,8 and 12 weeks after operation showed that there was an increasing trend the new bone for?mation in both experimental group and the control group ,and the experimental group was better;the trabecular bone structure of the blank group was scarce and the change was not obvious. Conclusion Allogenic tooth derived bone graft materials can promote the repair of bone defect ,and the effect is better than that of artificial bone repair materials.
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Objective To explore the clinical curative effect and complications of digital three-dimensional molding of titanium mesh for repairing skull defect. Methods The clinical data of 42 patients having underwent repairing skull defect with three-dimensional molding of titanium mesh were retrospectively analyzed. Results The average operation time was about 2 h, and 42 patients were operated successfully. The bilateral skull was symmetry and the appearance was good. In 42 patients, subcutaneous dropsy occurred in 1 case, epilepsy occurred in 3 cases, and intracranial bleeding again surgery occurred in 1 case. Patients were satisfied with the results of cranioplasty. Conclusions Repairing skull with digital three-dimensional molding of titanium mesh is simple, with shorter operation time, lower operation risk, and lower postoperative complication, and the clinical curative effect is satisfactory.
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Multiple methods and materials are available for bone defect reconstruction. Bone graft substitute is one of the materials used for reconstruction of bone defect and have been widely used recently. This report describes some cases about complications related to GeneX(R) which is introduced as mixture of calcium sulfate and beta-tricalcium phosphate at manufacturer's official web site. It informed of 3 patients who suffered wound inflammation, serous cyst after using GeneX(R) for reconstructing skull defect.
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Humans , Bone Substitutes , Calcium Sulfate , Inflammation , Postoperative Complications , Skull , Transplants , Wounds and InjuriesABSTRACT
Objective To study the repairing skull defect postoperative scalp raw muscle necrosis application as the clinical treatment of skin cream and tension suture technique.Methods A retrospective analysis of 26 cases of skull defect postoperative scalp necrosis in June 2007 to June 2014 was recorded.Given the tension suture after surgical debridement suture with raw muscle elephant skin creams besmear in the treatment of wounds.Results Twenty-four cases of scalp necrotic wounds healing,1 case was given after the repair material from the scalp necrotic wounds healing,1 case of secondary intracranial infection,given the repair material from brain abscesses clear postoperative wound healing.Conclusion Adopting the raw flesh like a skin cream for the treatment of tension suture after surgical debridement,can achieve rapid cure local infection,promote the healing of the scalp necrotic wounds,reduced the skull to operation failure and postoperative scalp defect repair necrosis repair material from risk,obtain ideal treatment effect.
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OBJECTIVE: The epidural fluid collection (EFC) as a complication of cranioplasty is not well-described in the literature. This study aimed to identify the predictive factors for the development of EFC as a complication of cranioplasty, and its outcomes. METHODS: From January 2004 to December 2012, 117 cranioplasty were performed in our institution. One-hundred-and-six of these patients were classified as either having EFC, or not having EFC. The two groups were compared to identify risk factors for EFC. Statistical significance was tested using the t-test and chi-square test, and a logistic regression analysis. RESULTS: Of the 117 patients undergoing cranioplasty, 59 (50.4%) suffered complications, and EFC occurred in 48 of the patients (41.0%). In the t-test and chi-test, risk factors for EFC were size of the skull defect (p=0.003) and postoperative air bubbles in the epidural space (p<0.001). In a logistic regression, the only statistically significant factor associated with development of EFC was the presence of postoperative air bubbles. The EFC disappeared or regressed over time in 30 of the 48 patients (62.5%), as shown by follow-up brain computed tomographic scan, but 17 patients (35.4%) required reoperation. CONCLUSION: EFC after cranioplasty is predicted by postoperative air bubbles in the epidural space. Most EFC can be treated conservatively. However, reoperation is necessary to resolve about a third of the cases. During cranioplasty, special attention is required when the skull defect is large, since EFC is then more likely.
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Humans , Brain , Epidural Space , Follow-Up Studies , Logistic Models , Reoperation , Risk Factors , SkullABSTRACT
Acalvaria é uma malformação congênita rara de patogênese desconhecida, na qual os ossos da abóbada craniana, a dura-máter e a musculatura associada estão ausentes, mas o sistema nervoso central costuma estar preservado. A teoria fisiopatogênica mais aceita sugere um defeito pós-neurulação, com disposição normal do ectoderma embrionário. O objetivo deste relato é descrever os achados de imagem neonatais da acalvaria primária.
Acalvaria is a rare congenital malformation of unknown pathogenesis characterized by the absence of the flat bones of the cranial vault, dura mater and associated muscles, while the central nervous system is usually preserved. The most accepted physiopathogenic theory suggests the presence of a postneurulation defect with normal placement the embryonic ectoderm. The present report describes neonatal imaging findings of primary acalvaria.
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Humans , Female , Infant, Newborn , Congenital Abnormalities , Craniofacial Abnormalities , Skull/abnormalities , Skull/growth & development , Craniofacial Abnormalities , Skin AbnormalitiesABSTRACT
PURPOSE: Among the materials for cranioplasty, autogenous bone is ideal because it is less susceptible to infection and has lower rates of subsequent exposure. However, the procedure is technically demanding to perform and requires a donor site. Disadvantages further exist when the defect is large and there are attendant limitations in donor site. The authors present their experience with reconstruction of large skull defect using right-angled zigzag osteotomized outer table of autogenous calvarial bone, overcoming the limitation in donor site. METHODS: From 2000 to 2006, 9 patients were retrospectively reviewed, who had undergone reconstruction with right angled zigzag osteotomized outer table of autogenous calvarial bone. RESULTS: Aesthetically satisfactory skull shape was achieved. Major complications of infection, hematoma, plate exposure, and donor site complications of dural tear with bleeding, cerebrospinal fluid leak, and meningitis were not seen. One patient had delayed wound healing and was successfully managed conservatively. CONCLUSION: Autogenous bone is the material of choice for cranioplasty, especially in complicated cases. Right angled zigzag osteotomy is a useful method in reconstruction of large skull defects with less donor site morbidity.
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Humans , Cerebrospinal Fluid , Hematoma , Hemorrhage , Meningitis , Osteotomy , Retrospective Studies , Skull , Tears , Tissue Donors , Wound HealingABSTRACT
Objective To select materials with high quality and safety and evaluate the clinical value of multi-point forming technique in skull repairing. Methods 161 patients suffered from skull defect had been cured in our hospital, within them 43 patients were treated with multi-point forming technique in titanium mesh shaping, 19 patients with traditional handwork shaping, 99 patients with bone-like concrete (acrylate). The following aspects were analyzed and compared: neurosurgeons' shaping workload before operations, operative time, approving scale on shaping and complications after operation. Results Repairing skull by titanium mesh with the technique of multipoint shaping significantly shortened the average operative time to (30 ?6) min, compared with acrylate group (70?18 min) and titanium mesh traditional handwork shaping group (50?11 min) (P
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Objective To discuss and analyze the diagnosis,management and surgical techniques for cranioplasty of skull vault defects and skull base reconstruction in order to raise the therapeutic effect. Methods The clinical data of 169 cases of skull vault and skull base defects treated with cranioplasty of skull vault defect and skull base reconstruction were retrospectively analyzed.Results Overlay tech- nique or inlay technique with imported titanium alloy mesh was used in 160 cases,and homologous bone was used in 9 cases.The surgical time ranged from 3 months to 8 years after injury.Eight cases presented with complications such as hematoma,subcutaneous effusion,infection and epilepsy postoperatively,but no operative death occurred.Conclusion For patients with skull vault defect with the diameter≥3 cm the best operative time is 3 months after injury,and for patients with intracranial and extracranial communica- ting tumors,skull base reconstruction can be performed when tumors are removed.Much attention should be paid to perioperative management and surgical skills.
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OBJECTIVE: Variable materials have been used in cranioplasty of skull defects, of which autologous bone is the most ideal. The authors explore methods and clinical results of cranioplasty with frozen autologous bone. METHODS: Cranioplasty was performed using frozen autologous bone in 16 patients with skull defects between August 1997 and April 1999. Primary diseases were severe head injury in 14 patients and cerebral infarction in two patients, and all of them received decompressive craniectomy. Cranioplasty were done from 25 to 225 days after primary operation. The mean follow-up period was 34 months. RESULTS: There was no infection or epidural hematoma. During the follow-up period, autologous bone flap were fused firmly to the skull without absorptive evidences and delayed complications. It was satisfactory in all cases when considered aesthetic aspects. CONCLUSION: Cranioplasty using frozen autologous bone is safe and satisfactory method for repair of surgically induced skull defects.
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Humans , Cerebral Infarction , Craniocerebral Trauma , Decompressive Craniectomy , Follow-Up Studies , Hematoma , SkullABSTRACT
We report a case of atretic cephaloce in a 7-month-old girl who presented with a growing left parietal painful mass, which was covered with excessive growth of thick scalp hairs and purplish discolored skin. Preoperative radiological studies revealed the left parietal round skull defect and epidural well enhancing mass without significant intradural parenchymal and vascular malformation. Total excision was done and histological diagnosis of atretic cephalocele was done. Characteristic histopathological features of this rare congenital anomaly with pertinent review of literatures were presented.
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Female , Humans , Infant , Diagnosis , Encephalocele , Hair , Rabeprazole , Scalp , Skin , Skull , Vascular MalformationsABSTRACT
We report a case of atretic cephaloce in a 7-month-old girl who presented with a growing left parietal painful mass, which was covered with excessive growth of thick scalp hairs and purplish discolored skin. Preoperative radiological studies revealed the left parietal round skull defect and epidural well enhancing mass without significant intradural parenchymal and vascular malformation. Total excision was done and histological diagnosis of atretic cephalocele was done. Characteristic histopathological features of this rare congenital anomaly with pertinent review of literatures were presented.
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Female , Humans , Infant , Diagnosis , Encephalocele , Hair , Rabeprazole , Scalp , Skin , Skull , Vascular MalformationsABSTRACT
Objective To analyze the superiority of implanting operation with autoskull stored at ultrahypothermia over low temperature's and frozen skull bone of oneself.Methods 42 case were observed and followed up after operation.Results Incision is healing by firct intention.there were many advantages,such as good biological activity,beautiful appearance,no repellent response,no immunoreaction and hard to infection,etc. After storing 1,3,6 and 12 months,the histological structure of frozen skull observed by electronscope was similar to those of fresh skull.Pestroyed skull bone cells were not found.All cases had no complication during the period of 3 to 12 months(mean 6.5 months) follow-up after operation.After 12 months,X ray and CT scan showed that skulls were healed.Conclusions Implanting operation with autoskull stored at ultra-hypothermia is one of the most effective technique for repairing skull defects.