Nguyen Phuong D, Khechoyan David Y, Phillips John H, Forrest Christopher R
Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, Philadelphia, PA 19104, United States.
Division of Plastic and Reconstructive Surgery, Children's Hospital of Colorado, 13123 E 16th Avenue, Aurora, CO 80045, United States.
J Plast Reconstr Aesthet Surg. 2018 Nov;71(11):1609-1617. doi: 10.1016/j.bjps.2018.07.016. Epub 2018 Aug 2.
CAD-CAM patient-specific implants offer cerebral protection and improved facial balance without the disadvantages of autologous bone grafting such as donor site morbidity and unpredictable resorption. Several alloplastic materials are available, but titanium, polymethylmethacrylate (PMMA), and polyetheretherketone (PEEK) are the current popular choices. We reviewed our experience of applying different alloplastic CAD-CAM materials in the reconstruction of complex pediatric craniofacial deformities.
A retrospective review was performed of all pediatric patients who underwent a complex inlay or onlay implant craniofacial reconstruction using CAD-CAM PEEK, PMMA, or titanium implants at a single institution. Demographics, cost, operative time, complications, and outcomes were assessed.
Between 2003 and 2014, 136 patients (69 male; 67 female; mean age 11.5 years (3-22 years); mean follow-up 30 months) had custom patient-specific craniofacial reconstruction with PEEK (n = 72), PMMA (n = 42), and titanium (n = 22) implants (inlay = 93; onlay = 43). Indications included congenital anomalies (26.5%), decompressive craniectomies (25.0%), craniofacial syndromes (25.7%), tumor defects (14.0%), and post-trauma (6.6%). Implant cost varied significantly for PEEK ($7703 CAD) and PMMA ($8328 CAD) compared with that for titanium ($11,980 CAD) (p < 0.0005). Six patients (4.4%) required surgery due to infection consisting of irrigation and antibiotic administration with successful implant salvage in three patients. All infections occurred in the PEEK group. Five patients (3.7%) ultimately had implants removed due to infection (n = 3), late exposure (titanium; n = 1), or late fracture (PMMA; n = 1).
CAD-CAM alloplast reconstruction in the management of complex pediatric craniofacial deformities is effective although expensive. Implant infection does not always require explantation. A reconstruction algorithm is presented.
计算机辅助设计与制造（CAD-CAM）定制植入物可为大脑提供保护，并改善面部平衡，且不存在自体骨移植的缺点，如供区并发症和不可预测的吸收。有几种异体材料可供选择，但钛、聚甲基丙烯酸甲酯（PMMA）和聚醚醚酮（PEEK）是目前常用的选择。我们回顾了我们在应用不同的异体CAD-CAM材料重建复杂小儿颅面畸形方面的经验。
对在单一机构接受使用CAD-CAM PEEK、PMMA或钛植入物进行复杂嵌体或覆盖植入物颅面重建的所有小儿患者进行回顾性研究。评估人口统计学、成本、手术时间、并发症和结果。
2003年至2014年期间，136例患者（男69例；女67例；平均年龄11.5岁（3 - 22岁）；平均随访30个月）接受了PEEK（n = 72）、PMMA（n = 42）和钛（n = 22）植入物的定制颅面重建（嵌体 = 93例；覆盖 = 43例）。适应证包括先天性畸形（26.5%）、减压性颅骨切除术（25.0%）、颅面综合征（25.7%）、肿瘤缺损（14.0%）和创伤后（6.6%）。与钛植入物（11,980加元）相比，PEEK（7703加元）和PMMA（8328加元）的植入成本差异显著（p < 0.0005）。6例患者（4.4%）因感染需要手术，包括冲洗和使用抗生素，3例患者成功保留了植入物。所有感染均发生在PEEK组。5例患者（3.7%）最终因感染（n = 3）、晚期暴露（钛；n = 1）或晚期骨折（PMMA；n = 1）而取出植入物。
CAD-CAM异体材料重建在复杂小儿颅面畸形的治疗中是有效的，尽管成本较高。植入物感染并不总是需要取出。本文提出了一种重建算法。
