The Combined Use of Composite Ceramic Granules and Fibrin Glue for Cranioplasties : Results of a Rat Model Study and Clinical Findings with Regard to Biocompatibility

水酸アパタイト・リン酸三カルシウム複合体顆粒(セラタイト^<(R)>)とフィブリン糊(ベリプラストP^<(R)>)を用いた頭蓋形成術を行った.動物実験では,ラット頭蓋骨を用い,本法の生体適合性を検討した.術後3ヶ月目の標本では,肉眼的には良好な頭蓋形成が得られたが,組織学的には新生骨は認められなかった.術後12カ月目の標本では,セラタイト^<(R)>を中心に新生骨が認められた.新生骨はセラタイト^<(R)>の表面に直接形成されており,また,一部にはセラタイト^<(R)>を取り囲むように新生骨が形成され,その顆粒の中にも新生骨が侵入しているのが観察された.以上の点から骨親和性および骨誘導能ともきわめて良好なことが示唆された.臨床的には開頭術後骨屑が少ない症例,再手術例への応用をはじめ,後頭蓋窩手術に伴う骨欠損の補嗔に応用した.術後の創感染はなく,良好な頭蓋形成が得られた.フィブリン湖を併用しているため髄液瘻の防止あるいは閉鎖にも有用であった.For cranioplasties, we have previously reported on the efficacy and safety of using a mixture of hydroxyapatite granules and the tricalciumphosphate composite (Ceratite^<(R)>) with fibrin glue (Beriplast P^<(R)>) . Continuing our research further, we have now investigated the biocompatibility of cranioplasty in rats. Two sets of Wistar rat (250-300 g) underwent a small craniectomy of the parietal bone, about 4 x 5 mm in size, without causing damage to the dura mater. The Ceratite^<(R)> in the form of granules, 0.3-0.6 mm in diameter, was then applied to the bone defect with Beriplast P^<(R)>. Postoperatively, at 3 and at 12 months, the results in each rat set, consisting of 6 rats each, were respectively evaluated. To accomplish this, 10 μm-thick sections from each set were prepared and stained with hematoxylin and eosin and examined under light microscopy. Results revealed that at 3 months postoperatively, there were signs that an excellent cranioplastic repair was in progress, but newly-formed bone had not yet to be seen among the Ceratite^<(R)> granules. However, at 12 months postoperatively, the repair appeared to be progressing well, for regenerated bone was observed amongst the Ceratite^<(R)> granules. Cranioplasties using Ceratite^<(R)> granules and Beriplast P^<(R)> have been performed for 22 neurosurgical patients, including one with a posterior fossa bone defect, and neither an infection nor local abnormal granulation were noted during the postoperative follow-up. These findings suggest that composite ceramics possess an excellent biocompatibility, and that the combined usage of composite granular ceramics and fibrin glue is both useful and safe for cranioplasties