Rekonstrukcija defekta lobanje 3D implantatom nakon sklopetarne povrede glave

  • Ana Malivuković Clinic for Plastic Surgery and Burns, Military Medical Academy, Belgrade, Serbia
  • Nenad Novaković Clinic for Neurosurgery, Military Medical Academy, Belgrade, Serbia
  • Milan Lepić Clinic for Neurosurgery, Military Medical Academy, Belgrade, Serbia
  • Ljubodrag Minić Clinic for Neurosurgery, Military Medical Academy, Belgrade, Serbia
  • Nenad Stepić Clinic for Plastic Surgery and Burns Military Medical Academy, Belgrade, Serbia, Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
  • Boban Djordjević Clinic for Plastic Surgery and Burns Military Medical Academy, Belgrade, Serbia, Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
  • Lukas Rasulić Clinic for Neurosurgery, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP150310043M
Ključne reči: skull||, ||lobanja, prosthesis and implants||, ||proteze i implantati, biocompatible materials||, ||biokompatibilni materijali, polyethylene glycols||, ||polietilen glikoli, polyetheretherketone||, ||polietereterketon, computer-aided design||, ||kompjuterski podržan dizajn, reconstructive surgical procedures||, ||hirurgija, rekonstruktivna, procedure,

Sažetak


Uvod. Kompleksni koštani nedostaci mogu imati različitu etiologiju i predstavljaju pravi izazov u rekonstruktivnoj hirurgiji. Zlatni standard kranioplastike je rekonstrukcija skinutom kosti lobanje, koja se u mnogim slučajevima ne može primeniti, naročito kod sklopetarnih povreda zbog destrukcije kosti. Rekonstrukcija autolognim graftom razdvajanjem kalvarija, rebrom ili ilijačnom kosti, takođe je moguća. Do sada primenjivani veštački materijali poput palakosa, titanijumskog meša i drugih, imaju brojne nedostatke i ograničenja. Prikaz bolesnika. Predstavljen je pacijent kome je nakon sklopetarne povrede glave ostao veliki koštani defekt frontalne regije sa zahvatanjem prednje lobanjske baze i otvorenim frontalnim sinusom. Nakon primarnog hirurškog zbrinjavanja i sprovedenog konzervativnog lečenja, šest meseci od povrede odlučeno je da se uradi rekonstrukcija nastalog koštanog defekta. Uzimajući u obzir sve relevantne medicinske faktore odlučeno je da se rekonstrukcija uradi primenom najsavremenijeg implantata od materijala PEEK-OPTIMA® koji je oblikovan na osnovu MSCT snimka u 3D tehnici. Ovaj materijal do sada nije korišćen na ovim prostorima. Neposredno i postoperativno praćenje sledećih 12 meseci pokazalo je tok bez komplikacija operativnog polja i neurološkog deficita, sa izuzetno zadovoljavajućim funkcionalnim i estetskim rezultatima. Zaključak. U toku primene ove nove hirurške intervencije uverili smo se da je proizveden implantat veoma precizno izrađen prema defektu i da je veoma pogodan kod zatvaranja kompleksnih i ekstenzivnih kranijumskih defekata. Naša prva iskustva idu u prilog očekivanju da će ovaj vid kranioplastike imati značajno mesto u rekonstruktivnoj hirurgiji defekata kostiju lica i glave.

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Objavljeno
2017/03/03
Broj časopisa
Vol. 73 Br. 8 (2016)
Rubrika
Prikaz bolesnika