摘要目的 探讨去骨瓣减压术后早期采用保留骨膜、体内保存的自体颅骨骨瓣行颅骨修补的可行性.方法 回顾性纳入日照市人民医院神经外科2012年1月至2015年12月采用去骨瓣减压术时保留骨瓣骨膜、体内皮下保存的方法行自体颅骨修补的患者67例.所有患者均于减压术后4～8周内进行修补.修补术时取部分骨组织行病理学检查以明确骨活性;术后所有患者常规行CT检查,34例患者行单光子发射计算机断层成像术(SPECT)检查,以明确自体颅骨愈合情况.结果 67例患者颅骨修补时,骨瓣大小基本如减压时;病理学检查未见骨细胞破坏、无灶性死骨形成,为正常骨性结构.修补术后随访1～2年,头颅CT扫描显示,修补术后1、6、12、24个月颅骨愈合率分别为0％、62.7％ (42/67)、100％ (67/67)、100％(53/53);随访期内无一例患者发生颅骨吸收.SPECT显示,患者颅骨血运良好,骨质存活良好.随访期内,1例(1.5％)发生皮下少量积血,4例(6.0％)出现皮下积液,无颅内及皮下感染.结论 去骨瓣减压术后,早期回植保留骨膜、体内保存的颅骨骨瓣,能很大程度上保留骨瓣的生物学特性,临床疗效好.

abstractsObjective To investigate the feasibility of preservation of the skull flap covered with periosteum in vivo and early cranioplasty in patients with decompressive craniectomy.Methods Sixtyseven patients underwent autologous cranioplasty using periosteum-covered skull flap preserved subcutaneously after decompressive craniectomy from Januay 2012 to December 2015 at Neurosurgery Department of Rizhao People's Hospital.Their data were retrospectively reviewed.Cranioplasty was conducted within 4-8 weeks after decompression for all patients.Part of the skull flap tissue was obtained in cranioplasty for identification of thc bone activity by pathological examination.At follow-up,all patients received CT scan and 34 patients underwent SPECT to assess the healing and survival of skull flap.Results The size of skull flap in the 67 patients with cranioplasty remained the same as that at the time of decompression.Bones were not destructed,focal dead bone was not observed by the pathological examination.The postoperative follow-up lasted 1-2 years and CT scans revealed that the healing rate was 0％,62.7％ (42/67),and (67/67),100％ (53/53) at 1,6,12,24 months after cranioplasty.No skull resorption was reported.Bone survival and good blood supply of the skull flap were demonstrated by SPECT.During the follow-up period,1 (1.5％) patient had small subcutaneous hematoma,4 (6.0％) patients developed subcutaneous effusion,and no intracranial or subcutaneous infection was observed.Conclusion Biological activities of skull flap in patients with decompressive craniectomy could remain well through subcutaneous preservation with periosteum,which might be useful for facilitating the good outcome of cranioplasty.