RU2197911C2 - Method for substituting cranial and dura mater defects - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves drilling holes in bone tissue near defect boundary after making surgical incision to access the cranial defect. Prosthesis is manufactured from protacryl and cranial defect imprint is produced in it. Three threads are introduced through the edge of yet soft prosthesis in the cranial holes projection positions using needle. Bone plate with dura mater on it is cut out from available human fetus cranium, the plate size being less than cranial defect size and dura mater envelope being greater than the defect size. The dura mater is brought under bone edges in the defect and the bone plate is set in the bone defect. Ligatures are brought through the prepared holes in the prosthesis. The prosthesis is set in the defect and attached to the cranium with threads. Bone plate and dura mater layer on it is attached to the prosthesis with ligatures. Soft tissues are sutured layer-by-layer over the prosthesis. EFFECT: high reliability of bone tissue regeneration. 2 cl

Description

 The invention relates to medicine, in particular to neurosurgery. Preferably, the invention can be used to replace a defect in the bones of the cranial vault and at the same time a defect in the dura mater in patients after resection trepanation.

 A known method of replacing a defect in the bones of the skull with self-hardening plastic. A skull prosthesis made from it can be easily modeled during surgery and can be given any shape, it has sufficient strength, performing protective functions immediately after surgery, is durable, has self-sterilization properties, is easily accessible and is not expensive to manufacture (A.R. Balabanov. Primary plastic surgery of skull defects (Moscow: Medicine, 1966, p. 86-89).

 The disadvantage of this method is that the skull prosthesis made of self-hardening plastic with a dura mater defect can have an irritating effect on the brain and subsequently lead to the formation of adhesions of the brain with tissues in the skull defect and other complications. In addition, the disadvantage of this method is the absence of signs in it that ensure the replacement of the dura mater defect and increase the reliability of the subsequent regeneration of bone tissue in the skull defect.

 Known plastic defect of the dura mater according to NN Burdenko, including splitting the dura mater of the patient into two sheets, followed by plastic defect separated one of them (B. A. Samotokin. From the book: "Surgery of the nervous system." Publisher Med.Lit. Medgiz.Len. Dep. 1959, p.181-182).

 The disadvantage of this method of plastics of the meninges is that it is possible with an undamaged meninges and with significant sizes of the skull defect, when it is possible to cut the flap next to the defect. This method leads to additional trauma, as it involves splitting the undamaged portion of the shell.

 It is also known to use canned dura for an adult for plasty of the defects of the dura mater (A.I. Arutyunov, N.Sh. Meskhia and VVVyaltsev. Replacing the defects of the dura mater with the same homotissue preserved at low temperatures. Methodical recommendations. M., 1974, 8 c).

 The disadvantage of this method of plasty of the defect of the dura mater is the absence of signs in it that contribute to the regeneration of bones in the skull defect, as well as the insufficient immobilization of the shell of the defect, the possibility of its bending into the cranial cavity with the formation of a cavity above it.

 Known invented by us method of cranioplasty for AS 942708 (MKI A 61 at 17/00. Authors: V.S. Starykh and Yu.N. Chertenkov), including exposure of the skull, resection of the edges of the bone wound, the formation of a prosthesis made of self-hardening plastic and fixing it with sutures to the skull. Moreover, in order to regenerate bone tissue under the prosthesis, the bone defect is filled with a mixture of bone crumbs and blood of the patient before closing.

 The disadvantage of this method is the absence of signs of the replacement of the dura mater defect in it, as well as the immobilization of the biomass mixture in the given position and increasing the reliability of the subsequent regeneration of bone tissue in the skull defect.

 We also know the invented method of cranioplasty according to the patent of the Russian Federation 1660244 (MKI A 61 B 17/56. Authors BCStarykh and V.Ya. Tarabrin), including exposure of the skull, resection of the edges of the bone wound, the formation of a prosthesis made of self-hardening plastic and fixing it with sutures to the skull . Moreover, in order to create the optimal thickness of the regenerate, the dura mater is fixed to the graft by ligatures through perforations at a distance of the thickness of the bone.

 The disadvantage of this method of cranioplasty is the lack of signs of the replacement of the dura mater in it, the reliable retention of the biomaterial in the required position and the specified thickness, as well as increasing the reliability of the subsequent regeneration of bone tissue in the skull defect.

 The closest in technical essence and the achieved result to the proposed method is a cranioplasty method according to the patent of the Russian Federation 1660244, which we take as a prototype, and its disadvantages are described above.

 The technical result of the invention is to expand the possibilities of replacing the defect of the dura mater and increase the reliability of the subsequent regeneration of bone tissue in the defect of the skull.

 The technical result is achieved by the fact that the method of replacing defects in the skull and dura mater involves introducing bone material into the cavity of the skull defect, closing the defect with a rigid graft and attaching it to the skull. The dura mater is fixed by ligatures through perforations in the graft. Then, a bone plate is cut out from the skull of a human fetus together with the dura mater on it in the shape of a skull defect, while the bone plate is formed smaller and the shell is larger than the skull defect. Next, the membrane is brought under the edges of the bone in the defect, and the bone plate is fixed with ligatures to the fixed rigid transplant.

 In a preferred embodiment of the method, the ligatures that fix the bone plate are made of long absorbable material.

 A specific example of the method. Patient B. with an impression of a multi-fragmented fracture of the bones of the cranial vault made a resection craniotomy. In connection with cerebral edema, the primary replacement of the dura mater and skull bones was not performed. Upon the disappearance of cerebral edema and wound healing, a reconstructive operation was performed. After a surgical incision with exposure of a skull defect and processing of its bone edge, holes are drilled at three points near the edge of the defect in the bone. A prosthesis is formed from self-hardening plastic, a prosthesis is formed, an imprint of a skull defect is made on it, and excess plastic is cut off. Three threads are drawn through the edge of the still soft prosthesis in the projection of the holes in the skull with a needle. From the harvested skull of a human fetus, a bone plate is cut out along with the dura mater on it, while the bone plate is formed smaller and the shell is larger than a skull defect. Long threads from the prosthesis are carried out through drilled holes in the bones. The bone plate is taken on ligatures from a long-absorbable polysorb material. Holding the ligatures, the dura mater is brought under the edges of the bone in the defect and the bone plate is placed in the bone defect. Ligatures are carried out through the formed holes in the prosthesis. When the ligatures are stretched, the prosthesis is installed in the defect and attached to the skull with threads. Ligatures fix the bone plate to the prosthesis with the dura mater located on it. Soft tissues are sutured in layers over the prosthesis.

 The significance of the differences of the claimed method from the selected prototype is as follows. The use of canned human fetal bone (brefosti) to replace defects in the skull bones is based on its low antigenic activity, faster restructuring, and increased stimulation of regenerate formation. The use of such brefomaterial together with the bone and the dura mater attached to it contributes to the simultaneous replacement of the defect in the bone and the dura mater defect, more reliable retention of the membrane on a fixed bone plate and improvement of the conditions for the formation of bone regenerate. The formation of a bone plate smaller than a skull defect allows it to be inserted into the defect cavity. Cutting the membrane larger than a skull defect allows drawing the edges of the membrane under the edges of the bone and achieving the fit of the transplanted membrane to the inner surface of the skull above the edge of its own dura mater, which helps to improve its growth conditions. The placement of the bone plate in the defect of the skull prevents the displacement of the membrane attached to it. Fixation of the bone plate with ligatures to a rigid graft mounted above the defect ensures reliable retention of the bone plate and canned shell on it in a predetermined position.

 The significance of the differences in the preferred embodiment of the method lies in the fact that the implementation of the ligatures that fix the bone plate from a long absorbable material, for example from polysorb, keeps the bone plate and shell for a period sufficient to increase the shell and to stimulate bone regeneration, and subsequent resorption this foreign material. It is known that polysorb has biocompatibility - the absence of toxic, allergic and teratogenic effects on the body. A thread from polysorb can degrade in the body. Due to biodegradation - the ability of such a suture material to disintegrate and excrete from the body, polysorb is absorbed in the body tissues by the 56-70th day (K.V. Puchkov and others. New synthetic suture materials in surgery. Ryazan 1994, 42 p.).

 Thus, the claimed method in the totality of its features provides the expansion of the possibilities of replacing the defect of the dura mater and increasing the reliability of the subsequent regeneration of bone tissue in the defect of the skull, which improves the quality of treatment and improves long-term results, leading to an economic effect.

 The application of the invention is possible in pediatric and field surgery, as well as in veterinary medicine.

Claims (2)

 1. A method for replacing defects in the skull and dura mater, including introducing bone material into the cavity of the skull defect, closing the defect with a rigid graft and attaching it to the skull, while the dura mater is fixed with ligatures through perforations in it, characterized in that it is first from the fetal skull a bone plate is cut out together with the dura mater on it in the shape of a skull defect, while the bone plate is formed smaller and the shell is larger than the skull defect, then One edge of the bone is in a defect, and the bone plate is fixed with ligatures to a rigid graft.  2. The method according to claim 1, characterized in that the ligatures that fix the bone plate are made of a long absorbable material.