新重建科技於頭部外傷行開顱減壓手術後之應用：三面體鈦合金網的角色

Abstract

在患者接受開顱減壓手術後，功能的重建及美觀與患者接下來的生活品質可說是息息相關。由於現今生物材質科技的進步，以三面體或三維鈦金屬網 (3-dimensional titanium mesh) 行顱骨成型術已成為因開顱手術導致顱骨缺損患者的一項新選擇。此研究則在觀察曾經接受三維鈦金屬網植體行顱骨成型術的患者，術後在外觀上或是手術預後上或是合併症上的一項回顧。回顧的個案總共40位（其中31位是接受單側顱骨切開術，9位是接受雙側顱骨切開術），這些患者是由2008年1月始在我們的醫院接受經電腦協助設計下的鈦金屬網植體植入 (computer-assisted designed titanium mesh implant)。檢視的重點包括外型美觀、第五對、第七對腦神經功能和其它相關合併症（植入物膨出、腦膜炎、骨髓炎、腦部膿瘍及氣腦）。評估結果發現頭臉部的對稱性、植入物的穩定性和功能上評估的成果都非常另人滿意。沒有一個患者被發現有三叉神經或臉部功能的異常。術後患者不論是以Ｘ光影像、個人或家人的審視眼光來看，都達到了整體美觀的效果。而其中有兩位患者產生延遲性的傷口癒合及後續輕度的傷口感染，但經過兩週的抗生素治療後也都痊癒。以三維鈦金屬網植體做為頭臉部骨骼重建，就術後頭臉部整體輪廓的美觀上，可行性可說是非常好的，術後患者能擁有較好的生活品質和極低的合併症。相對其它材質而言，鈦金屬網植體之重建可為較大範圍顱骨缺損的患者提供一個更優質的選擇。

Functional and aesthetic reconstruction after wide decompressive craniectomy directly correlates with subsequent quality of life. Advancements in the development of biomaterials have now made three-dimensional (3-D) titanium mesh a new option for the repair of skull defects after craniectomy. The purpose of this study was to review aesthetic and surgical outcomes and complications of patients who had skull defects repaired with 3-D titanium mesh. The records of 40 adult patients (31 unilateral craniectomies and 9 bilateral craniectomies) who underwent a computer-assisted designed titanium mesh implant at our institute from January 2008 were retrospectively reviewed. Aesthetic outcomes, cranial nerve V and VII function, and complications (hardware extrusions, meningitis, osteomyelitis, brain abscess, and pneumocephalus) were evaluated. The craniofacial symmetry, implant stability, and functional outcomes were excellent for all patients. No patients had trigeminal or facial dysfunction. All had excellent cosmetic results as measured by post-reduction radiographs and personal and family perceptions of the forehead contour. Two patients had delayed wound healing and subsequent subclinical wound infections, which resolved after treatment with antibiotics for 2 weeks. Craniofacial skeletal reconstruction with 3-D titanium mesh results in excellent forehead contour and cosmesis, and subsequently a better quality of life with few complications. Titanium mesh reconstruction offers a favorable alternative to other graft materials in the repair of large skull defects.