Calcium Phosphate Cements in Skull Reconstruction: A Meta-Analysis
Calcium Phosphate Cements in Skull Reconstruction: A Meta-Analysis
复制标题
DOI：
10.1097/prs.0b013e3181ead057
复制
发表时间：
2010-10-01
影响因子：
3.6
通讯作者：
Zins, James E.
中科院分区：
文献类型：
--
作者：
Afifi, Ahmed M.;Gordon, Chad R.;Zins, James E.
背景：本研究通过对已发表文献的荟萃分析，解决了关于磷酸钙骨水泥在颅骨重建中的适应症和结果的争议。方法：在PubMed检索报道磷酸钙骨水泥用于颅骨重建的文章。收集的数据包括年龄、骨水泥体积、缺损大小、使用的材料、随访时间、与鼻窦相通的位置或照射区域的位置以及并发症。结果：19篇文章符合作者的纳入标准。平均并发症发生率如下：总并发症13%（范围0 ~ 62%）；严重并发症，9%（范围0 - 62%）；轻微并发症，2%（范围，0 - 5%）；感染，5%（范围0 - 22%）；再手术，14%（范围0 - 62%）；二次手术矫正轮廓占1%（范围0 - 12%）。总并发症和主要并发症、感染和再手术的估计率存在显著的异质性（p < 0.001），但轻微并发症和二次轮廓矫正的异质性较小（p = 0.58和p = 0.78）。放疗与鼻窦相通明显增加并发症发生率（p < 0.05）。从手术到并发症的平均时间为17.5个月（范围为1至89个月）。结论：在我们的荟萃分析中，磷酸钙水泥的平均并发症发生率和并发症范围与之前使用甲基丙烯酸甲酯或自体骨的大型颅骨成形术研究相比，磷酸钙水泥的效果并不比其他方法好，有时甚至更差。因此，磷酸钙只能选择性使用，需要前瞻性的长期研究来进一步完善其在颅骨重建中的作用。(塑料。Reconstr。[j] .地理学报，2010。
Background: This work addresses the controversy regarding the indications and results of calcium phosphate cements in skull reconstruction through a meta-analysis of the published literature.Methods: A PubMed search for articles reporting the use of calcium phosphate cements for skull reconstruction was performed. Data collected included age, volume of cement, defect size, material used, length of follow-up, placement in communication with paranasal sinuses or in irradiated fields, and complications.Results: Nineteen articles met the authors' inclusion criteria. The mean rates of complications were as follows: total complications, 13 percent (range, 0 to 62 percent); major complications, 9 percent (range, 0 to 62 percent); minor complications, 2 percent (range, 0 to 5 percent); infection, 5 percent (range, 0 to 22 percent); reoperation, 14 percent (range, 0 to 62 percent); and secondary surgery for contour correction, 1 percent (range, 0 to 12 percent). There was significant heterogeneity in the estimated rate of total and major complications, infection, and reoperation (p < 0.001), but minor complications and secondary contour correction had less heterogeneity (p = 0.58 and p = 0.78, respectively). Radiotherapy and communication with the paranasal sinuses significantly increased the complication rate (p < 0.05). Duration between surgery and complications averaged 17.5 months (range, 1 to 89 months).Conclusions: When mean complication rate and complication range of calcium phosphate cements in our meta-analysis were compared with previous large cranioplasty studies using methylmethacrylate or autogenous bone, calcium phosphate fared no better, and sometimes fared worse, than these other modalities. Calcium phosphate, therefore, should only be used selectively, and prospective long-term studies are needed to further refine its role in skull reconstruction. (Plast. Reconstr. Swig. 126: 1300, 2010.)