The biocompatible hydroxyapatite cement (HAC) is a welcome alternative to the traditional use of autogenous bone for postoperative corrections of cranial vault irregularities. The authors performed experimental studies to show the safety and osseointegration capacity of HAC on animal models and confirm the osseous replacement without toxic reactions. The purpose of the current study was to analyze the clinical outcome after correction of secondary cranial vault irregularities with HAC. Twenty-one patients were treated for residual cranial frontal bone defects after craniotomy with HAC (Bone Source, Stryker Leibinger GmbH, D-79111 Freiburg, Germany). The average age was 38.5 years (range, 23-57 years). All of the patients were male. The average volume per patient was 53.83 g. The volume implanted ranged from 25 to 125 g; in all cases the dura was covered with bone. Irregularities resulted from sunken bone. The authors' clinical series demonstrates that a satisfactory and aesthetically pleasing result can be achieved in one surgical intervention in patients for surgical correction of postoperative cranial vault irregularities using HAC. It permits osseointegration, which makes it relatively resistant to infection. HAC is easy to apply and shape to suit individual needs. HAC is a welcome alternative to the traditional use of autogenous bone for postoperative corrections of cranial vault irregularities.
ZusammenfassungDas Ziel der Untersuchung war es, das Biopolymer Ethisorb® vergleichend mit dessen experimenteller Modifikation Ethisorb® Rapid sowie mit bzw. ohne Zusätze von autogenen Spongiosachips hinsichtlich der Osteoiddichte und damit die Frühphase der Knochenregeneration histomorphometrisch und -morphologisch zu untersuchen. Hierzu wurden die beiden Biopolymere in Defekte kritischer Größe des Tibiamarkraums an insgesamt 20 Göttinger Miniaturschweinen implantiert. Die postoperativen Standzeiten betrugen sechs, 12, 26 und 52 Wochen. Die vergleichsweise höchsten Osteoiddichten resultierten sechs bzw. zwölf Wochen postoperativ für Ethisorb® ,8 %) und Ethisorb® mit Spongiosachips (jeweils 0,9 %, p = 0,05). Zur Optimierung der Frühphase der Knochenregeneration bieten sich neben dem osteokonduktiv wirkenden Ethisorb® zusätzlich osteoinduktive autogene Spongiosachips an, die eine polytope Knochenregeneration mit appositionellen Osteoidbanden hervorrufen. Die ermittelte Osteoiddichte kann zur Beurteilung der frühen Knochenregeneration bis zwölf Wochen postoperativ herangezogen werden.
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