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首页> 外文期刊>Plastic and reconstructive surgery >Demineralized Bone Matrix and Resorbable Mesh Bilaminate Cranioplasty Is Ineffective for Secondary Reconstruction of Large Pediatric Cranial Defects
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Demineralized Bone Matrix and Resorbable Mesh Bilaminate Cranioplasty Is Ineffective for Secondary Reconstruction of Large Pediatric Cranial Defects

机译：脱矿质骨基质和可再吸收的网状纤维串颅骨成形术对大型儿科颅缺损的二次重建是无效的

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摘要

Replacement of the autologous bone flap after decompressive craniectomy can be complicated by significant osteolysis or infection with large defects over scarred dura. Demineralized bone matrix is an alternative to autologous reconstruction, effective when reconstructing large defects using a resorbable mesh bilaminate technique in primary cranioplasty, but this technique has not been studied for revision cranioplasty and the setting of scarred dura. Retrospective review was performed of patients receiving demineralized bone matrix and resorbable mesh bilaminate cranioplasty for postdecompressive craniectomy defects. Seven patients (mean age, 4.2 years) were identified with a mean follow-up of 4.0 years. Computed tomography before the demineralized bone matrix and resorbable mesh bilaminate cranioplasty and at least 1 year postoperatively were compared. Defects were characterized and need for revision was assessed. All patients had craniectomy with associated hemidural scarring. Five patients had autologous bone flap cranioplasty associated with nearly total osteolysis, and two patients had deferral of bone flap before demineralized bone matrix and resorbable mesh bilaminate cranioplasty. Demineralized bone matrix and resorbable mesh bilaminate cranioplasty demonstrated unpredictable and poor ossification, with bony coverage unchanged at postoperative follow-up. All patients required major revision cranioplasty at a mean time of 2.5 years. Porous polyethylene was successfully used in six of the revisions, whereas exchange cranioplasty was used in the remaining patient, with a mean follow-up of 1.4 years. Although demineralized bone matrix and resorbable mesh bilaminate is appropriate for primary cranioplasty, it should be avoided in the setting of scarred or infected dura in favor of synthetic materials or exchange cranioplasty.
机译：在减压颅骨切除术后替换自体骨瓣术可以通过显着的骨溶解或感染在疤痕的Dura上具有大量缺陷。脱矿质骨基质是自体重建的替代方案，当使用原发性颅骨成形术中使用可再吸收的网状纤维素技术重建大缺陷时，但是该技术尚未研究修订颅骨成形术和疤痕的硬阵的设置。对接受脱矿质骨基质的患者进行回顾性评论，可再分解颅骨切除术缺陷的可再生网格纤维植物成形术。七名患者（平均年龄，4.2岁）被确定为40岁的平均随访。在脱矿质骨基质和可再吸收的网状植物颅骨成形术之前计算断层扫描，比较了至少1年。缺陷的特征在于，评估了修订。所有患者患有相关的血液瘢痕，所有患者都有颅骨切除术。 5例患者出现近总骨质溶解相关的自体骨瓣颅骨修补术，2例有延期骨瓣的脱钙骨基质和再吸收网状物双层层压件颅骨修补之前。脱矿质骨基质和可再吸收的网状植物颅骨成形术展示了不可预测和差的骨化，在术后随访中没有骨质覆盖率。所有患者均需要大型修复颅骨成形术，平均时间为2.5岁。多孔聚乙烯成功用于六个修订，而交换颅骨成形术在剩余的患者中使用，平均随访1.4岁。虽然脱矿质骨基质和可再吸收的网状素酸盐适用于原发性颅骨成形术，但应避免在疤痕或感染的硬脑膜中避免，有利于合成材料或交换颅骨成形术。

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