Zanotti Bruno, Zingaretti Nicola, Verlicchi Angela, Robiony Massimo, Alfieri Alex, Parodi Pier Camillo
*Neurosurgery Clinic†Department of Plastic and Reconstructive Surgery, University of Udine, Udine‡Neurology Unit, Free University of Neuroscience "Anemos," Reggio Emilia§Department of Maxillo-facial Surgery, University of Udine, Udine, Italy||Clinic of Neurosurgery, Ruppiner Kliniken GmbH, Neuruppin, Germany.
J Craniofac Surg. 2016 Nov;27(8):2061-2072. doi: 10.1097/SCS.0000000000003025.
Cranioplasty remains a difficult procedure for all craniofacial surgeons, particularly when concerning the reconstruction of large lacunae in the skull. Considering the significant clinical and economic impact of the procedure, the search for materials and strategies to provide more comfortable and reliable surgical procedures is one of the most important challenges faced by modern craniofacial medicine.The purpose of this study was to compare the available data regarding the safety and clinical efficacy of materials and techniques currently used for the reconstruction of the skull. Accordingly, the scientific databases were searched for the following keywords autologous bone, biomaterials, cranial reconstruction, cranioplasty, hydroxyapatite, polyetheretherketone, polymethylmethacrylate, and titanium. This literature review emphasizes the benefits and weaknesses of each considered material commonly used for cranioplasty, especially in terms of infectious complications, fractures, and morphological outcomes.As regards the latter, this appears to be very similar among the different materials when custom three-dimensional modeling is used for implant development, suggesting that this criterion is strongly influenced by implant design. However, the overall infection rate can vary from 0% to 30%, apparently dependent on the type of material used, likely in virtue of the wide variation in their chemico-physical composition. Among the different materials used for cranioplasty implants, synthetics such as polyetheretherketone, polymethylmethacrylate, and titanium show a higher primary tear resistance, whereas hydroxyapatite and autologous bone display good biomimetic properties, although the latter has been ascribed a variable reabsorption rate of between 3% and 50%.In short, all cranioplasty procedures and materials have their advantages and disadvantages, and none of the currently available materials meet the criteria required for an ideal implant. Hence, the choice of cranioplasty materials is still essentially reliant on the surgeon's preference.
颅骨成形术对于所有颅面外科医生来说仍然是一项困难的手术，尤其是在涉及颅骨大缺损的重建时。考虑到该手术对临床和经济的重大影响，寻找能够提供更舒适、可靠手术方法的材料和策略是现代颅面医学面临的最重要挑战之一。本研究的目的是比较目前用于颅骨重建的材料和技术在安全性和临床疗效方面的现有数据。因此，在科学数据库中搜索了以下关键词：自体骨、生物材料、颅骨重建、颅骨成形术、羟基磷灰石、聚醚醚酮、聚甲基丙烯酸甲酯和钛。这篇文献综述强调了每种常用于颅骨成形术的材料的优缺点，特别是在感染并发症、骨折和形态学结果方面。关于后者，当使用定制三维建模进行植入物开发时，不同材料之间的情况似乎非常相似，这表明该标准受植入物设计的影响很大。然而，总体感染率可能在0%至30%之间变化，显然取决于所用材料的类型，这可能是由于它们的化学物理组成差异很大。在用于颅骨成形术植入物的不同材料中，聚醚醚酮、聚甲基丙烯酸甲酯和钛等合成材料具有较高的初始抗撕裂性，而羟基磷灰石和自体骨具有良好的仿生性能，尽管后者的再吸收率在3%至50%之间变化不定。简而言之，所有颅骨成形术的手术方法和材料都有其优缺点，目前可用的材料均未达到理想植入物所需的标准。因此，颅骨成形术材料的选择在很大程度上仍依赖于外科医生的偏好。
