Jaberi Joby, Gambrell Kenneth, Tiwana Paul, Madden Chris, Finn Rick
Division of Oral and Maxillofacial Surgery, UT Southwestern Medical Center, Dallas, TX 75390-9109, USA.
J Oral Maxillofac Surg. 2013 Feb;71(2):e81-8. doi: 10.1016/j.joms.2012.09.023.
The goal of secondary cranioplasty is permanent cerebral protection in an esthetically acceptable fashion. Reconstruction of cranial defects can be performed with several different materials. Alloplastic materials, such as preformed methyl-methacrylate (PMMA) cranioplasties, are an alternative frequently used at our institution. This retrospective analysis was designed to review the outcomes of PMMA cranioplasty for skull defect reconstruction.
Seventy consecutive patients who had 78 PMMA cranioplasties placed from 2003 through 2010 were identified. Mechanism of injury, location of cranioplasty, type of original repair, postoperative complications, and follow-up time were reviewed.
Of the 70 patients, 6 patients had failure and removal of their original PMMA cranioplasty and reinsertion of another, and 2 patients had failure and removal of 2 cranioplasties with replacement of a third, creating a total of 78 PMMA cranioplasties placed. The predominant mechanism of injury was trauma (64%). The most frequent postoperative complication was infection (13%). With the exception of the 2 patients with implant exposure, no patients reported an unacceptable cosmetic result. An overall complication rate of 24% was seen.
The results of previous studies have shown that infection and complication rates of cranioplasties accomplished with bone cement are substantially higher, that titanium-based implants may obscure follow-up imaging for tumor patients, and that the outcomes regarding hydroxyapatite-based ceramics, although similar to PMMA, are associated with a much higher cost. PMMA remains a cost-effective and proven method to repair cranial defects that fulfills the goals of cranial reconstruction for skull defects.
二期颅骨成形术的目标是以美学上可接受的方式实现永久性脑保护。颅骨缺损的重建可以使用几种不同的材料。异体材料，如预制的聚甲基丙烯酸甲酯（PMMA）颅骨成形物，是我们机构经常使用的一种替代材料。本回顾性分析旨在评估PMMA颅骨成形术用于颅骨缺损重建的效果。
确定了2003年至2010年期间连续接受78次PMMA颅骨成形术的70例患者。回顾了损伤机制、颅骨成形术的位置、初始修复类型、术后并发症和随访时间。
70例患者中，6例患者的原始PMMA颅骨成形物失败并被移除，重新植入另一个；2例患者的2个颅骨成形物失败并被移除，替换为第三个，总共植入了78个PMMA颅骨成形物。主要损伤机制是创伤（64%）。最常见的术后并发症是感染（13%）。除2例植入物外露的患者外，没有患者报告美容效果不佳。总体并发症发生率为24%。
先前的研究结果表明，使用骨水泥进行颅骨成形术的感染和并发症发生率要高得多，钛基植入物可能会妨碍肿瘤患者的后续影像学检查，基于羟基磷灰石的陶瓷虽然与PMMA相似，但其结果与更高的成本相关。PMMA仍然是一种经济有效的、经证实的修复颅骨缺损的方法，符合颅骨缺损重建的目标。
