Rekonstrukcija defekata lobanje: veštački materijali i autograft

Abstract

Postoji veliki broj stanja koja za posledicu mogu imati nastanak defekata lobanje. Od samih početaka hirurgije kao medicinske discipline i veštine, popravka defekata u kostima, koje ostaju posle traume, vaskularne patologije ili tumora, predstavljala je izazov za neurohirurge. Glavni cilj bio je efikasno povratiti normalne barijere koje štite intrakranijalne strukture, obezbediti trajnu ili barem dugotrajnu rekonstrukciju, vratiti pritisak u kranijumu u normalu, što za rezultat često ima povlačenje patoloških neuroloških znakova, kao i postići zadovoljavajuće estetske rezultate. Kako je medicina, a u okviru medicine najviše hirurgija i imunologija, napredovala glavni metod za rekonstrukciju lobanje postala je upotreba koštanih transplantata, rebarnih graftova i graftova kostiju lobanje (split calvaria). Ipak, čak i koštani autograft ima neke nedostatke. U određenim situacijama, rekonstrukcija urađena koštanim graftom može dovesti do specifičnih komplikacija, među kojima su najčešće infekcije i resorpcija koštanog grafta. Kod velikih defekata lobanje, pogotovo kod pacijenata koji se leče od politraume, kost je često polomljena u veliki broj segmenata koji se ne mogu povezati i koristiti na zadovoljavajući način, ili bi ceo proces predugo trajao. Cilj ove doktorske disertacije bio je analizirati slučajeve kranijalnih rekonstrukcija u našoj Klinici u kojima je korišćen metilmetakrilat i koštani autograft, uporediti procenat komplikacija, i bliže objasniti faktore koji na pojavu komplikacija utiču. Konačno, cilj je doći do validnih preporuka za rekonstruktivne hirurge u vezi sa odlukom da li u određenom slučaju treba koristiti metilmetakrilat ili koštani autograft. Istraživanje je urađeno u obliku retrospektivno-prospektivne kohortne studije u koju su bili uključeni pacijenti kojima je urađena kranioplastika u Klinici za neurohirurgiju Vojnomedicinske akademije u Beogradu. Studija je obuhvatila pacijente koji su operisani u periodu od januara 2010. godine do decembra 2013. godine...

There are many conditions which can result in cranial defects. Since the very beginnings of surgery as a medical field and craft, the repair of bone defects, often remaining after traumatic, vascular or tumor lesions, represented a challenge for neurosurgeons. The main goal has always been to efficiently repair the barriers protecting the intracranial structures, allow for a permanent or at least semi-permanent reconstruction, restore the cranial pressure to its normal state, resulting also in the normalization of pathological neurological signs, as well as achieve satisfactory esthetic results. As medicine, and most importantly surgery and immunology progressed, so have progressed the different methods available for skull reconstruction. The main methods have become the use of bone auto transplants, rib grafts and split calvaria grafts. Nevertheless, even the bone auto graft can have some disadvantages. In some situations, a reconstruction done using a bone auto graft can lead to specific complications, most commonly infection and resorption of the bone graft. In large bone defects, especially in patients treated for polytrauma, the bone is often broken into a large number of small segments which cannot be put together in a satisfactory fashion, or the whole process would last too long. The aim of this doctoral dissertation was to analyze all the patients treated at our Clinic to whom the cranial reconstruction was done using autologous bone and methilmethacrylate, to compare the number and percentage of complications, and closer explain the factors which could influence them. Finally, the aim was to arrive to valid recommendations for reconstructive surgeons regarding the decision to use methilmethacrylate or bone auto graft in specific situations. This study was done as a retrospective-prospective cohort study in which all patients to whom a cranial reconstruction was done using autologous bone or methilmethacrylate in the period from January 2010 until December 2013 were included...