Worm Paulo Valdeci, do Nascimento Tobias Ludwig, do Couto Nicola Fabricio, Sanches Eduardo Farias, Dos Santos Moreira Carlos Fernando, Rogério Luiz Pedro Willimann, Dos Reis Marcelo Martins, Finger Guilherme, Collares Marcus Vinicius Martins
Department of Surgical Sciences, Post Graduation Program in Medicine, Porto Alegre Clinical Hospital, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil; Neurosurgery Department of Cristo Redentor Hospital, Porto Alegre, Rio Grande do Sul, Brazil.
Neurosurgery Department of Cristo Redentor Hospital, Porto Alegre, Rio Grande do Sul, Brazil.
Surg Neurol Int. 2016 Nov 9;7(Suppl 28):S746-S751. doi: 10.4103/2152-7806.193725. eCollection 2016.
In cases where autologous bone graft reconstruction is not possible (such as comminuted fractures, bone graft reabsorption, or infection) and the use of synthetic material is required, polymethylmethacrylate (PMMA) use is a safe and efficient solution. Studies comparing the incidence of postoperative complications between autologous and synthetic cranioplasty are heterogeneous, not allowing a conclusion of which is the best material for skull defects reconstruction. Current medical literature lacks prospective well-delineated studies with long-term follow-up that analyze the impact of antibiotic use in PMMA cranial reconstruction of moderate and large defects.
A prospective series of patients, who underwent cranioplasty reconstruction with PMMA impregnated with antibiotic, were followed for 2 years. Authors collected data regarding demographic status, clinical conditions, surgical information, and its complications.
A total of 58 patients completed full follow-up with a mean group age of 40 years and a male predominance (77%). Major complications that required surgical management were identified in 5 patients, and 10 patients evolved with minor complications. Postoperative surgical site infection incidence was 3.2%.
The infection rate in patients submitted to PMMA flap cranioplasty impregnated with antibiotic is significantly inferior comparing to the data described in medical literature. A lower infection incidence impacts secondary endpoints such as minimizing surgical morbidity, mortality, hospitalization period, and, consequently, costs.
在自体骨移植重建不可行的情况下（如粉碎性骨折、骨移植吸收或感染）且需要使用合成材料时，聚甲基丙烯酸甲酯（PMMA）的应用是一种安全有效的解决方案。比较自体和合成颅骨成形术后并发症发生率的研究存在异质性，无法得出哪种材料是颅骨缺损重建的最佳材料的结论。当前医学文献缺乏对使用抗生素的PMMA颅骨重建中、大型缺损的影响进行长期随访的前瞻性明确研究。
对一系列使用含抗生素的PMMA进行颅骨成形重建的患者进行了为期2年的随访。作者收集了有关人口统计学状况、临床情况、手术信息及其并发症的数据。
共有58例患者完成了完整随访，平均年龄40岁，男性占多数（77%）。5例患者出现需要手术处理的主要并发症，10例患者出现轻微并发症。术后手术部位感染发生率为3.2%。
与医学文献中描述的数据相比，接受含抗生素的PMMA皮瓣颅骨成形术的患者感染率明显较低。较低的感染发生率对次要终点有影响，如将手术发病率、死亡率、住院时间降至最低，从而降低成本。
