Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
Neurosurgery. 2011 Apr;68(4):1124-9; discussion 1130. doi: 10.1227/NEU.0b013e31820a5470.
Infection is a significant cause of morbidity with cranioplasty procedures. However, few studies have investigated the effect of specific surgical practices on cranioplasty infection.
To analyze the literature on the effect of early surgery (within 3 months of craniectomy), implant material, and method of flap preservation on cranioplasty infections, and to perform a subanalysis of the effect of early surgery on overall complications associated with cranioplasty.
A systematic search of the PubMed, Cochrane, SCOPUS, and CINAHL databases was conducted. Comparative studies that reported on timing of surgery, implant material (autograft vs allograft), or method of flap preservation (subcutaneous vs extracorporeal), and infection or complication rates were selected for detailed analysis. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for each analysis.
Eighteen articles (2254 data points) met criteria for inclusion. There was no difference in infection rates (OR, 1.35; 95% CI, 0.53-3.41; P = .53) or overall complication rates (OR, 0.57; 95% CI, 0.29-1.11; P = .10) between early or later surgery. Fourteen studies (n = 1582) compared infection rates between autograft and allograft materials; there was no difference in infection rates between the two (OR, 0.81; 95% CI, 0.40-1.66; P = .57). There was no significant difference in infection rates between subcutaneous or extracorporeal preservation (OR, 0.35; 95% CI, 0.09-1.35; P = .13).
Analysis of the best current evidence suggests that early surgery, implant material, and method of flap preservation have no effect on the rate of cranioplasty infections.
感染是颅骨成形术的主要发病原因之一。然而，很少有研究调查特定手术操作对颅骨成形术感染的影响。
分析有关早期手术（颅骨切除术后 3 个月内）、植入材料和皮瓣保存方法对颅骨成形术感染的影响的文献，并对早期手术对颅骨成形术相关总体并发症的影响进行亚分析。
对 PubMed、Cochrane、SCOPUS 和 CINAHL 数据库进行系统检索。选择报告手术时间、植入材料（自体移植物与同种异体移植物）或皮瓣保存方法（皮下与体外）以及感染或并发症发生率的比较研究进行详细分析。计算了每个分析的汇总优势比（OR）和 95%置信区间（CI）。
18 篇文章（2254 个数据点）符合纳入标准。早期或晚期手术在感染率（OR，1.35；95%CI，0.53-3.41；P=.53）或总体并发症率（OR，0.57；95%CI，0.29-1.11；P=.10）方面均无差异。14 项研究（n=1582）比较了自体移植物和同种异体移植物材料的感染率，两者的感染率无差异（OR，0.81；95%CI，0.40-1.66；P=.57）。皮下或体外保存的感染率也无显著差异（OR，0.35；95%CI，0.09-1.35；P=.13）。
对现有最佳证据的分析表明，早期手术、植入材料和皮瓣保存方法对颅骨成形术感染率没有影响。
