Meta-Analysis and Meta-Regression of Complications and Failures of Autologous Heterotopic Cranial Bone versus Alloplastic Cranioplasties.
Meta-Analysis and Meta-Regression of Complications and Failures of Autologous Heterotopic Cranial Bone versus Alloplastic Cranioplasties.
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自体异位颅骨与异体颅骨成形术并发症和失败的荟萃分析和荟萃回归。
DOI：
10.1097/prs.0000000000011093
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发表时间：
2023
影响因子：
3.6
通讯作者：
Lee,JustineC
中科院分区：
文献类型：
--
作者：
Oberoi,MichelleK;Mirzaie,Sarah;Huang,KellyX;Caprini,RachelM;Hu,VivianJ;Dejam,Dillon;Ge,Shaokui;Cronin,BrendanJ;Pfaff,MilesJ;Lee,JustineC
新鲜自体颅骨移植物传统上被认为是理想的颅骨成形术材料，然而文献中缺乏与现代同种异体材料结果的长期比较。在这项工作中，我们评估了新鲜、异位、颅骨移植物与三种常见同种异体材料进行颅骨成形术的并发症和失败。方法对1971-2021年间发表的研究进行对数变换比例随机效应荟萃分析，以评估使用新鲜、自体、异位颅骨、聚醚醚酮（PEEK）、聚甲基丙烯酸甲酯（PMMA）或钛进行颅骨成形术的并发症和失败，平均随访≥12个月。采用广义混合模型元回归来解释异质性并评估调节因子对结果变量的贡献。结果纳入1490例患者，平均年龄（33.9±10.8）岁。全因并发症合计，新鲜异位自体颅骨为6.2%(95%可信区间[CI]: 2.1-17.0%; I2= 55.0%, p= 0.02)， PEEK为18.5% (95% CI: 14.0-24.0%; I2= 0.0%, p= 0.58)，钛为26.1% (95% CI: 18.7-35.1%; I2= 60.6%, p< 0.01)， PMMA为28.4% （95% CI: 12.9-51.5%; I2= 88.5%, p< 0.01）。全因失败率为：新鲜自体颅骨为2.2% (95% CI: 0.4-10.6%; I2= 0.0%, p= 0.45)， PEEK为6.3% (95% CI: 3.2-12.3%; I2= 15.5%, p= 0.31)，钛为11.4% (95% CI: 6.7-18.8%; I2= 60.8%, p< 0.01)， PMMA为12.7% （95% CI: 6.9-22.0%; I2= 64.8%, p< 0.01）。meta回归模型显示，各同种异体亚型均可独立预测更高的并发症，而钛和PMMA是全因失败的重要预测因子。与自体骨相比，所有三种亚型都预示着继发于感染的颅骨成形术失败率更高。结论与同种异体材料相比，新鲜自体异位颅骨移植手术并发症和失败率较低。
BackgroundFresh autologous cranial bone graft has been traditionally regarded as the ideal cranioplasty material, however long-term comparisons of outcomes with modern alloplastic materials are absent in the literature. In this work, we evaluated complications and failures among cranioplasties performed with fresh, heterotopic, cranial bone graft versus three common alloplastic materials.MethodsRandom-effects meta-analyses of logit-transformed proportions were performed on studies published between 1971-2021 to evaluate complications and failures of cranioplasties performed with fresh, autologous, heterotopic cranial bone, polyetheretherketone (PEEK), polymethylmethacrylate (PMMA), or titanium with a mean follow-up≥ 12 months. Generalized mixed model meta-regressions were performed to account for heterogeneity and to evaluate the contributions of moderators to outcomes variables.Results1490 patients (mean age 33.9±10.8 years) were included. Pooled, all-cause complications were 6.2% for fresh, heterotopic, autologous cranial bone (95% confidence interval [CI]: 2.1-17.0%; I2= 55.0%, p= 0.02), 18.5% for PEEK (95% CI: 14.0-24.0%; I2= 0.0%, p= 0.58), 26.1% for titanium (95% CI: 18.7-35.1%; I2= 60.6%, p< 0.01), and 28.4% for PMMA (95% CI: 12.9-51.5%; I2= 88.5%, p< 0.01). Pooled all-cause failures were 2.2% for fresh, autologous cranial bone (95% CI: 0.4-10.6%; I2= 0.0%, p= 0.45), 6.3% for PEEK (95% CI: 3.2-12.3%; I2= 15.5%, p= 0.31), 11.4% for titanium (95% CI: 6.7-18.8%; I2= 60.8%, p< 0.01), and 12.7% for PMMA (95% CI: 6.9-22.0%; I2= 64.8%, p< 0.01). Meta-regression models indicated that each alloplastic subtype significantly and independently predicted higher complications, while titanium and PMMA were significant predictors for all-cause failures compared to autologous bone. All three subtypes were predictive of higher cranioplasty failures secondary to infection compared to autologous bone.ConclusionsCranioplasties performed with fresh, autologous heterotopic cranial bone grafts resulted in lower complications and failures compared to alloplastic materials.