Craniofacial reconstruction with computer-generated HTR patient-matched implants: Use in primary bony tumor excision
Craniofacial reconstruction with computer-generated HTR patient-matched implants: Use in primary bony tumor excision
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DOI：
10.1097/00001665-200209000-00011
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发表时间：
2002-09-01
影响因子：
0.9
通讯作者：
Eppley, BL
中科院分区：
文献类型：
--
作者：
Eppley, BL
本临床系列的目的是报告计算机生成的异体硬组织置换（HTR）植入物与同期骨肿瘤切除术联合用于重建颅眶区大缺损的有效性和安全性。7名患者患有前颅穹窿和眼眶的大型非恶性骨病变，同时进行了骨切除和术前制造的定制异体植入物重建。术前，获得3D计算机断层扫描（CT）扫描，根据该扫描制作解剖模型。在解剖模型上，进行预测的骨切除量。然后使用模型中的缺损来创建用于重建和手术放置的异体（HTR聚合物）植入物。手术时，使用金属或可吸收接骨板和螺钉将植入物固定到位。在额窦靠近植入物的情况下，将额窦颅骨化并用颅骨瓣覆盖或用羟基磷灰石骨水泥闭塞。由于骨切除量大于术前计划，所有计算机生成的植入物都需要在术中进行一些修改。这是通过修改植入物的无菌备份作为原始植入物的补充或使用羟基磷灰石骨水泥完成骨缺损重建来实现的。所有患者均顺利愈合，至少随访1年（平均2.6年）。在所有病例中，均保持了良好的轮廓，所有患者均保持无感染。在颅眶区大型良性骨肿瘤的治疗中，可以根据对后续骨缺损的估计，在术前使用由多孔亲水性HTR聚合物制成的定制植入物进行同步重建。这种入路的成功使用取决于受体部位良好的组织质量、术前对将切除的骨量的慷慨估计，以便植入物足够、术中扩张植入物重建的技术以及术中确保植入物与额窦分离的方法。
The aim of this clinical series is to report the effectiveness and safety of using computer-generated alloplastic hard tissue replacement (HTR) implants for the reconstruction of large defects of the cranio-orbital region when combined with simultaneous bone tumor excision. Seven patients who had large nonmalignant bony lesions of the anterior cranial vault and orbit underwent simultaneous bony excision and reconstruction with preoperatively fabricated custom alloplastic implants. Preoperatively, a 3D computed tomography (CT) scan was obtained from which an anatomical model was fabricated. On the anatomical model, the predicted amount of bone excision was performed. The defect in the model was then used to create an alloplastic (HTR polymer) implant for reconstruction and surgical placement. At the time of surgery, the implant was secured into position with either metal or resorbable plates and screws. In cases where the frontal sinus was in proximity to the implant, it was either cranialized and covered with a pericranial flap or obliterated with hydroxyapatite cement. All computer-generated implants required some modification intraoperatively due to a larger amount of bony excision than was preoperatively planned. This was accomplished by modifying the sterile back-up of the implant as an addition to the original implant or completing reconstruction of the bony defect with hydroxyapatite cement. All patients have healed uneventfully with a minimum of 1 year follow-up (average, 2.6 years). In all cases, excellent contours have been maintained and all patients have remained infection-free. In the management of large benign bony tumors of the cranio-orbital region, simultaneous reconstruction with custom implants fabricated from porous, hydrophilic HTR polymer can be preoperatively fabricated based on an estimate of the subsequent bony defect. The successful use of this approach depends on a favorable tissue quality of the recipient site, a generous preoperative estimate of the amount of bone that will be resected so that the implant is adequate, intraoperative techniques of expanding the implant reconstruction, and intraoperative methods to assure a partitioning of the implant from the frontal sinus.