Outcomes of Cranioplasty Strategies for High-Risk Complex Cranial Defects: A 10-Year Experience.
Outcomes of Cranioplasty Strategies for High-Risk Complex Cranial Defects: A 10-Year Experience.
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DOI：
10.1097/sap.0000000000003019
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发表时间：
2022-06-01
影响因子：
1.5
通讯作者：
Myers RP
中科院分区：
文献类型：
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作者：
Soto E;Restrepo RD;Grant JH 3rd;Myers RP
虽然文献包含有关获得的缺陷的并发性并发性并发性的风险和并发症的报道，但很少有出版物针对特定的患者人群，这些患者人群需要在先前感染，辐射，大规模相关的软组织创伤之前需要进行此类重建。我们将这种临床表现为大型表面积重新建设。我们的目标是比较敌对颅骨缺陷中自体骨和同种异体重建的安全性和功效。
IRB对在2008年1月至2018年12月之间在阿拉巴马大学 - 伯明翰进行敌对现场的颅骨成形术的患者进行了回顾性审查。根据所使用的植入物的类型将患者分为三组：自源（骨），同种塑料（PEEK，钛，PMMA）或混合（骨骼和假肢的组合）。主要结局度量是在颅骨成形术后的一年，通过植入物衰竭，坏死或感染确定的一年。统计分析包括t检验和卡方检验，适用于SPSS。
在此期间总共有55例； 27自动源，23个同种塑料和5个混合。纯粹的自源组的并发症率最高（44％），同种塑料组的并发症率最低（38％），这在这三组之间在统计学上没有差异（p = 0.121）。当通过用于重建的特定材料（27个骨头，14个PEEK，10个钛和5 PMMA）进行分层时，总体并发症率在统计学上是显着的（P = 0.009； Chi Square测试），PEEK植入物的并发症率最低（21％）。
这项分析有趣地发现，在敌对的颅骨缺陷的情况下，颅骨形态会受益于使用假体植入物而不是自体骨移植物，这不仅是为了避免供体部位的发病率，而且还可以减少整体复杂性。
While the literature contains reports of the risks and complications of calvarial vault reconstruction for acquired defects, there are few publications addressing the specific patient population who require such reconstructions in cases in preceded by prior infection, radiation, massive associated soft tissue trauma etc. We define such clinical presentations as a hostile environment for large surface area reconstruction. Our objective is to compare the safety and efficacy of autologous bone and alloplastic reconstruction in hostile cranial defects. An IRB approved retrospective review of patients who underwent cranioplasty of a hostile site at the University of Alabama - Birmingham between January 2008 and December 2018 was performed. The patients were stratified into three groups based on the type of implant used: autogenous (bone), alloplastic (PEEK, Titanium, PMMA), or mixed (combination of bone and prosthetic). The primary outcome metric was a complication in the year following cranioplasty, identified by implant failure, necrosis, or infection. Statistical analysis included t-tests and chi-square tests where appropriate using SPSS. There were 55 total cases in this time period; 27 autogenous, 23 alloplastic, and 5 mixed. The purely autogenous group had the highest complication rate (44%) and the alloplastic group had the lowest complication rate (38%) that was not statistically different between the three groups (p=0.121). When stratified by specific material used for reconstruction (27 bone, 14 PEEK, 10 titanium, and 5 PMMA), overall complication rate was statistically significant (p=0.009; chi square test) with PEEK implants having the lowest complication rate (21%). This analysis interestingly found that in the setting of hostile cranial defects, cranioplasties would benefit from the use of prosthetic implants instead of autologous bone grafts, not only for avoidance of donor site morbidity but also for decrease in overall complications.