Honeybul Stephen, Morrison David Anthony, Ho Kwok M, Lind Christopher R P, Geelhoed Elizabeth
Department of Neurosurgery, Sir Charles Gairdner Hospital, 1 Hospital Avenue, Nedlands, Perth, WA, Australia.
Royal Perth Hospital, Wellington Street, Perth, WA, 6000, Australia.
Acta Neurochir (Wien). 2018 May;160(5):885-891. doi: 10.1007/s00701-018-3514-z. Epub 2018 Mar 15.
To compare the long-term outcomes of patients who had been randomly allocated to receive primary titanium cranioplasty or autologous bone graft following decompressive craniectomy.
Sixty-four patients had been previously enrolled and randomised to receive either their own bone graft or a primary titanium cranioplasty. Functional and cosmetic outcomes had previously been assessed at 1-year following the cranioplasty procedure. Hospital records and the Picture Archiving communication system were reviewed to determine how many patients had cranioplasty failure or associated complications such as seizures beyond 1 year-with a minimum of 24-month follow-up.
Amongst the 31 patients in the titanium group (one patient had died), no patients had a partial or complete cranioplasty failure at 12 months follow-up and there had been no failures beyond 12 months. Amongst the 31 patients who had an autologous cranioplasty (one patient had died), 7 patients had complete resorption of the autologous bone such that it was adjudged a complete failure at 12-month follow-up. Five of these patients had had titanium augmentation and two patients declined further surgery. Both of these patients requested cranial augmentation for functional and cosmetic reasons subsequent to the 12-month follow-up. Another patient who had previously been noted to have moderate resorption at 12 months presented 1 year later with progressive bone flap resorption and also required subsequent augmentation for functional and cosmetic reasons. When follow-up was extended to a minimum of 24 months, use of titanium instead of autologous bone for primary cranioplasty resulted in a significant reduction in the number of patients who required rescue cranioplasty (0 vs 25%, 95% confidence interval [CI] 9.1-42.1%; p = 0.001). In addition, there were significantly less total hospital healthcare costs in those patients randomised to the titanium arm of the trial (difference = A$9999, 95%CI 2231-17,768; p = 0.015).
Bone resorption continued to occur beyond 12 months after autologous cranioplasty; use of primary titanium cranioplasty after decompressive craniectomy reduced the number of reoperations needed and the associated long-term total hospital costs.
比较减压性颅骨切除术后随机分配接受一期钛网颅骨成形术或自体骨移植患者的长期预后。
先前纳入64例患者并随机分为接受自体骨移植或一期钛网颅骨成形术。先前在颅骨成形术后1年评估了功能和美容效果。查阅医院记录和图像存档与通信系统，以确定在至少24个月的随访中，有多少患者发生颅骨成形术失败或出现癫痫等相关并发症。
钛网组31例患者（1例死亡）中，随访12个月时无患者出现部分或完全颅骨成形术失败，12个月后也无失败病例。自体颅骨成形术组31例患者（1例死亡）中，7例患者自体骨完全吸收，在随访12个月时判定为完全失败。其中5例患者进行了钛网修补，2例患者拒绝进一步手术。这2例患者在随访12个月后因功能和美容原因要求颅骨修补。另1例患者在12个月时曾有中度吸收，1年后出现骨瓣渐进性吸收，也因功能和美容原因需要后续修补。当随访延长至至少24个月时，一期颅骨成形术使用钛网而非自体骨导致需要补救性颅骨成形术的患者数量显著减少（0%对25%，95%置信区间[CI]9.1 - 42.1%；p = 0.001）。此外，随机分配至试验钛网组的患者总住院医疗费用显著更低（差值 = 9999澳元，95%CI 2231 - 17768；p = 0.015）。
自体颅骨成形术后12个月后仍持续发生骨吸收；减压性颅骨切除术后使用一期钛网颅骨成形术可减少再次手术的需求及相关的长期总住院费用。
