Volsky Peter G, Hillman Todd A, Stromberg Kellen J, Buchinsky Farrel J, Chen Douglas A, Jackson Neal M, Arriaga Moisés A
Pittsburgh Ear Associates, Philadelphia, Pennsylvania.
Division of Otolaryngology, Philadelphia, Pennsylvania.
Laryngoscope. 2017 Sep;127(9):2120-2125. doi: 10.1002/lary.26403. Epub 2017 Jan 6.
To report the authors' experience with hydroxyapatite cement (HAC) cranioplasty and analyze the material's long-term safety and efficacy in repairing translabyrinthine skull-base defects by examining adverse events, specifically cerebrospinal fluid (CSF) leaks and surgical site infections.
Retrospective case-control study (primary study arm); prospective cross-sectional study of patients not examined within the last 5 years (secondary arm).
tertiary-care neurotology private practice and academic practice (two centers).
Hydroxyapatite cement implanted following translabyrinthine approach, with or without fat graft, was included. Combined approaches were excluded. Implant-associated adverse events were defined as 1) CSF leaks requiring reoperation or spinal drainage, and (2) infections requiring reoperation. Patients not examined within 5 years were interviewed by telephone to update their condition. Incidence of adverse events was compared to published data for translabyrinthine cranioplasty using fat graft alone. Implant survival analysis was performed.
The study cohort included 369 HAC implants in the same number of patients. There were seven CSF leaks and seven infections. Combined (n = 14) incidence of adverse events was 3.8% (2.09%, 6.28%). Compared to fat graft alone, the adverse events associated with HAC were fewer (P < 0.001). Up to 15 years (5,475 days), HAC cement maintained 95% adverse event-free survival. There were no cases of meningitis.
Cranioplasty using HAC with autologous fat following translabyrinthine skull-base surgery is safer and more effective than fat graft alone, up to 15 years after surgery.
报告作者使用羟基磷灰石骨水泥（HAC）进行颅骨成形术的经验，并通过检查不良事件，特别是脑脊液（CSF）漏和手术部位感染，分析该材料在修复经迷路入路颅底缺损中的长期安全性和有效性。
回顾性病例对照研究（主要研究组）；对过去5年内未接受检查的患者进行前瞻性横断面研究（次要研究组）。
三级医疗神经耳科私人诊所和学术机构（两个中心）。
纳入经迷路入路后植入羟基磷灰石骨水泥（无论是否使用脂肪移植）的病例，排除联合入路的病例。植入相关不良事件定义为：（1）需要再次手术或脊髓引流的脑脊液漏；（2）需要再次手术的感染。对过去5年内未接受检查的患者进行电话随访以更新其病情。将不良事件的发生率与仅使用脂肪移植进行经迷路颅骨成形术的已发表数据进行比较。进行植入物生存分析。
研究队列包括369例患者植入的369个HAC。发生了7例脑脊液漏和7例感染。不良事件的合并发生率（n = 14）为3.8%（2.09%，6.28%）。与仅使用脂肪移植相比，与HAC相关的不良事件更少（P < 0.001）。长达15年（5475天），HAC骨水泥的无不良事件生存率维持在95%。无脑膜炎病例。
经迷路颅底手术后使用HAC联合自体脂肪进行颅骨成形术，在术后长达15年的时间里，比仅使用脂肪移植更安全、更有效。
4。《喉镜》，2017年，第127卷，第2120 - 2125页。
