Titanium miniplates or stainless steel wire for cranial fixation: a prospective randomized comparison.
Titanium miniplates or stainless steel wire for cranial fixation: a prospective randomized comparison.
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DOI：
10.3171/jns.2002.96.2.0244
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发表时间：
2002-02
影响因子：
4.1
通讯作者：
W. Broaddus;K. Holloway;C. Winters;M. Bullock;R. Graham;B. Mathern;J. Ward;H. Young
中科院分区：
文献类型：
--
作者：
W. Broaddus;K. Holloway;C. Winters;M. Bullock;R. Graham;B. Mathern;J. Ward;H. Young
目的：作者设计了一项研究，比较低切迹钛微型钢板固定与不锈钢钢丝固定。方法40例患者在接受开颅手术前均签署知情同意书，并随机接受钢丝或微型钢板固定。硬膜闭合后，定时进行骨瓣固定。测量骨瓣的向内或向外偏移以及在其边缘手动压力下的移动性。术后3个月，对骨瓣边缘的外观或触诊偏移以及是否存在钻孔凹陷进行分级。24例患者随机接受微型钢板固定，16例接受不锈钢丝固定。钢丝固定所需时间比微型板长约40%（11.8 +/- 5.1分钟与8.3 +/- 5分钟，p = 0.02）。钢丝固定后骨瓣的偏移量明显大于微型钢板（1.6 +/- 1 mm与0.3 +/- 0.6 mm，p < 0.001），骨瓣在手指压力下的活动度也是如此（1.2 +/- 0.9 mm与0.2 +/- 0.5 mm，p < 0.001）。在3个月的随访审查中，12例患者中有2例在钢丝固定后结果不佳，而14例患者中无1例在微型钢板固定后结果不佳。当将术后结果分为优秀或不太优秀时，接受微型钢板固定的患者的数据明显更好（p < 0.05）。结论：钛微型接骨板颅骨固定提供了更准确和更刚性的骨边缘再对合，在仔细检查或触诊时结果明显更好。因此，在许多情况下，微型钢板固定的额外费用是合理的。
OBJECT The authors designed a study to compare low-profile titanium miniplate fixation to that in which stainless steel wire is used. METHODS Before undergoing craniotomy, 40 patients gave informed consent and were randomized to receive either wire or miniplate fixation. After dural closure, bone flap fixation was timed. The bone flap was measured for inward or outward offset and mobility to manual pressure on its margin. Three months postoperatively the bone flap margins were graded for appearance or palpation of an offset and for the presence of burr hole depressions. Twenty-four patients were randomized to receive miniplate fixation and 16 to receive stainless steel wire fixation. The time required for wire fixation was approximately 40% longer than that for miniplates (11.8 +/- 5.1 minutes compared with 8.3 +/- 5 minutes, p = 0.02). The offset of bone flaps after wire fixation was significantly greater than that with miniplates (1.6 +/- 1 mm compared with 0.3 +/- 0.6 mm, p < 0.001), as was the mobility of the bone flap on digital pressure (1.2 +/- 0.9 mm compared with 0.2 +/- 0.5 mm, p < 0.001). At the 3-month follow-up review, two of 12 patients had suboptimal results after wire fixation, whereas none of 14 patients had suboptimal results after miniplate fixation. When dichotomized for excellent or less-than-excellent postoperative results, the data were significantly better for patients who underwent miniplate fixation (p < 0.05). CONCLUSIONS Titanium miniplate cranial fixation provides more accurate and rigid reapproximation of the bone edges, with results that are significantly better on close inspection or palpation. The additional cost of miniplate fixation may thus be justified in many cases.