Lopez Joseph, Zhong Shuting Susan, Sankey Eric W, Swanson Edward W, Susarla Harlyn, Jusue-Torres Ignacio, Huang Judy, Brem Henry, Auwaerter Paul G, Gordon Chad R
Baltimore, Md.; and Rockford, Ill. From the Departments of Plastic and Reconstructive Surgery and Neurosurgery, and the Division of Infectious Disease, The Johns Hopkins University School of Medicine; and the University of Illinois College of Medicine.
Plast Reconstr Surg. 2016 Feb;137(2):394e-404e. doi: 10.1097/01.prs.0000475770.14396.1e.
Reinfections following implant-based cranioplasty, in the setting of previous bone flap osteomyelitis, are common and associated with significant morbidity. The timing of reconstruction following initial osteomyelitic bone flap removal remains controversial; most advocate for prolonged time intervals of approximately 6 to 12 months. Thus, the authors investigated their delayed cranioplasty outcomes following both early (between 90 and 179 days) and late (≥ 180 days) time intervals with custom craniofacial implants to determine whether timing affected outcomes and rates of reinfection.
An institutional review board-approved retrospective cohort review of 25 consecutive cranioplasties, from 2012 to 2014, was conducted. A nonparametric bivariate analysis compared variables and complications between the two different time interval groups, defined as early cranioplasty (between 90 and 179 days) and cranioplasty (≥ 180 days).
No significant differences were found in primary and secondary outcomes in patients who underwent early versus late cranioplasty (p > 0.29). The overall reinfection rate was only 4 percent (one of 25), with the single reinfection occurring in the late group. Overall, the major complication rate was 8 percent (two of 25). Complete and subgroup analyses of specific complications yielded no significant differences between the early and late time intervals (p > 0.44).
The results suggest that early cranioplasty is a viable treatment option for patients with previous bone flap osteomyelitis and subsequent removal. As such, a reduced time interval of 3 months--with equivalent outcomes and reinfection rates--represents a promising area for future study aiming to reduce the morbidity surrounding prolonged time intervals.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
在先前骨瓣骨髓炎的情况下，基于植入物的颅骨成形术后再感染很常见，且与严重的发病率相关。初次骨髓炎骨瓣切除术后重建的时机仍存在争议；大多数人主张延长约6至12个月的时间间隔。因此，作者研究了使用定制颅面植入物在早期（90至179天之间）和晚期（≥180天）时间间隔后延迟颅骨成形术的结果，以确定时间是否会影响结果和再感染率。
对2012年至2014年连续25例颅骨成形术进行了机构审查委员会批准的回顾性队列研究。采用非参数双变量分析比较了两个不同时间间隔组（定义为早期颅骨成形术（90至179天之间）和晚期颅骨成形术（≥180天））之间的变量和并发症。
早期与晚期颅骨成形术患者的主要和次要结果无显著差异（p>0.29）。总体再感染率仅为4%（25例中的1例），唯一的再感染发生在晚期组。总体而言，主要并发症发生率为8%（25例中的2例）。对特定并发症的完整和亚组分析显示，早期和晚期时间间隔之间无显著差异（p>0.44）。
结果表明，早期颅骨成形术是先前骨瓣骨髓炎及随后切除患者的一种可行治疗选择。因此，缩短3个月的时间间隔——具有相当的结果和再感染率——是未来旨在降低长期时间间隔相关发病率的研究有前景的领域。
临床问题/证据水平：治疗性，III级。
