Thien Ady, King Nicolas K K, Ang Beng Ti, Wang Ernest, Ng Ivan
Department of Neurosurgery, National Neuroscience Institute, Singapore.
Department of Neurosurgery, National Neuroscience Institute, Singapore.
World Neurosurg. 2015 Feb;83(2):176-80. doi: 10.1016/j.wneu.2014.06.003. Epub 2014 Jun 5.
To characterize complication and failure rates and outcomes of patients who underwent cranioplasty with polyetheretherketone (PEEK) and titanium implants and to compare complication and failure rates between the 2 implants.
A retrospective cohort study of patients who underwent cranioplasty with PEEK patient-specific implant (PEEK Optima-LT) and preformed titanium mesh at the National Neuroscience Institute, Singapore, between January 2001 and February 2012 was performed. Data related to initial decompressive craniectomy and cranioplasty, associated complications after cranioplasty, and indication for revision or removal of implants were collected. Cranioplasty failure was defined as revision or removal of a patient's implant.
Overall complication rates for PEEK and titanium cranioplasty were 25.0% and 27.8%, respectively. The combined complication rate was 27.3%. A trend toward increase in exposed implant in titanium cranioplasty compared with PEEK cranioplasty was observed (P = 0.074). There were 3 of 24 (12.5%) cranioplasty failures with PEEK, and 27 of 108 (25%) cranioplasty failures with titanium (P = 0.129). Previous deep infection in patients after decompressive craniectomy was associated with cranioplasty complications (odds ratio, 23.3; confidence interval, 3.00-180.5; P = 0.003) and failure (odds ratio, 22.5; confidence interval, 2.82-179.0; P = 0.003).
The findings from this study highlight that cranioplasty is associated with significant complications, including the necessity for reoperation. It is hoped that the information in this study will provide better understanding of the risks associated with PEEK and titanium cranioplasty and contribute to decision making by the clinician and patient.
描述接受聚醚醚酮（PEEK）和钛植入物颅骨成形术患者的并发症、失败率及预后，并比较两种植入物的并发症和失败率。
对2001年1月至2012年2月期间在新加坡国立神经科学研究所接受使用定制PEEK植入物（PEEK Optima-LT）和预制钛网进行颅骨成形术的患者进行回顾性队列研究。收集与初次减压性颅骨切除术和颅骨成形术、颅骨成形术后相关并发症以及植入物翻修或取出指征相关的数据。颅骨成形术失败定义为患者植入物的翻修或取出。
PEEK和钛颅骨成形术的总体并发症发生率分别为25.0%和27.8%。联合并发症发生率为27.3%。观察到与PEEK颅骨成形术相比，钛颅骨成形术中植入物外露有增加趋势（P = 0.074）。24例接受PEEK颅骨成形术的患者中有3例（12.5%）失败，108例接受钛颅骨成形术的患者中有27例（25%）失败（P = 0.129）。减压性颅骨切除术后患者先前的深部感染与颅骨成形术并发症（比值比，23.3；置信区间，3.00 - 180.5；P = 0.003）和失败（比值比，22.5；置信区间，2.82 - 179.0；P = 0.003）相关。
本研究结果表明颅骨成形术与包括再次手术必要性在内的严重并发症相关。希望本研究中的信息能使人们更好地了解与PEEK和钛颅骨成形术相关的风险，并有助于临床医生和患者做出决策。
