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Посттравматические дефекты
черепа у детей, особенности
краниопластики
обширных дефектов
А.Г. Тимершин
Республиканская детская клиническая больница
Нейрохирургическое отделение
г. Уфа
По возрасту
 от 1 года до 3 лет – 2
 от 3 до 6 лет

– 6

 от 6 до 16 лет

– 30
По локализации


Теменная кость - 14

Лобная - 14
 Височная - 4
 основания черепа - 4
 множественной локализации - 2

Размеры дефектов


Малые (до 10 см2) - 21 больных



Средние (до 30 см2)– 13



Большие (до 60 см2) – 2



Обширные (более 60 см2) - 3
ПРИЧИНЫ ДЕФЕКТОВ
 Оскольчатые переломы
 Послеоперационные
 Вдавленные переломы
 Послеожоговые
Показания к оперативному
вмешательству:
 наличие дефекта тканей черепа
более 2 см в диаметре
МАТЕРИАЛЫ ДЛЯ ПЛАСТИКИ

Аутокость-16
 Аллотрансплантат -26
 Металлическая пластина-2
 Аутодермопластика-3

Первичная аутопластика
произведена у 12 больных
 у 26 детей – плановая поздняя ауто и
аллокраниопластика.



Первичная костная пластика
произведена пострадавшим в первые 1-2
суток от времени получения ЧМТ.
Пластика дефектов произведена
аутокостью и собственной костной
крошкой после устранения вдавленных
переломов черепа с ревизией эписубдурального пространства.






Поздняя краниопластика произведена в
сроки от 4 месяцев до 5 лет после ЧМТ.
Для пластики применяли
аллотрансплантат фирмы «Аллоплант».
У 8 больных ПТДЧ сочетались с
дефектами твердой мозговой оболочки
(ТМО) с наличием оболочечно-мозговых
рубцов, что требовало проведения
пластической реконструкции ТМО.
У 4-х пациентов поздняя
аутокраниопластика проводилась
расщепленным костным лоскутом на
питающей ножке.
Посттравматические дефекты черепа
Осложнения:





частичное рассасывание
аутотрансплантанта- у 2 больных,
резорбция аллотрансплантанта у 3,
осложнения гнойно-воспалительного
характера наблюдались у 2 больных.
Непосредственной причиной
осложнений являлись повторные травмы
области трансплантата, общие
воспалительные заболевания после
операции
 У 3-х больных проводилась

пластика обширных дефектов
тканей черепа
Электротравма с повреждением мягких тканей,
костей черепа, ТМО, затылочной доли головного
мозга у мальчика 10 лет
Посттравматические дефекты черепа
ПХО поврежденного участка мозга, пластика ТМО
Посттравматические дефекты черепа
Посттравматические дефекты черепа
Пересадка мышц спины на сосудистой ножке
Микрососудистый анастомоз
Посттравматические дефекты черепа
Посттравматические дефекты черепа
Посттравматические дефекты черепа
Подготовка к кожной пластике
Посттравматические дефекты черепа
После расщепленной
аутодермопластики
3 месяца после электротравмы
1 год после операций
Б-й А., 14 лет после ДТП- дефект мягких
тканей, лобной кости, эпидуральная гематома
Этапы лечения
Посттравматические дефекты черепа
Грануляции
Кожная пластика
Б-й Ю., 10 лет после тяжелого
электроожога
Посттравматические дефекты черепа
Посттравматические дефекты черепа
Аутодермопластика
БЛАГОДАРЮ ЗА ВНИМАНИЕ!

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Посттравматические дефекты черепа