自体骨颅骨成形术：一位外科医生 42 年的经验回顾。
Autogenous Bone Cranioplasty: Review of a 42-Year Experience by a Single Surgeon.
机构信息
From the Department of Plastic and Reconstructive Surgery, Nicklaus Children's Hospital; the Herbert Wertheim College of Medicine, Florida International University; and the Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center.
出版信息
Plast Reconstr Surg. 2019 Jun;143(6):1713-1723. doi: 10.1097/PRS.0000000000005677.
BACKGROUND
Autogenous bone is frequently espoused as the gold standard material for cranioplasty procedures, yet alloplastic cranioplasty continues to persist in the search, presumably, for a simpler technique. Although short-term outcomes can be successful using foreign materials, long-term follow-up in these patients often demonstrates increased rates of failure because of exposure or late infection. Autogenous bone grafts, however, integrate and revascularize, and are thus more resistant to infection than alloplastic materials.
METHODS
This is a retrospective review of all patients that underwent reconstructive cranioplasty for full-thickness defects, as performed by the senior author (S.A.W.) between 1975 and 2018. All procedures were performed with autogenous bone.
RESULTS
One hundred fifty-four patients met criteria for inclusion in the report. Cranioplasties were performed for both congenital and secondary indications. Split calvaria was used in 115 patients (74.7 percent), rib graft was used in 12 patients (7.8 percent), iliac crest graft was used in 10 patients (6.5 percent), and combinations of donor-site grafts were used in 17 patients (11.0 percent). In the entire series, none of the patients suffered from complications related to infection of either the donor site or transferred bone graft. None of the patients required secondary operations to fill in defects created by the postoperative resorption.
CONCLUSIONS
Although autologous bone is widely considered the gold standard material for cranioplasty procedures, some argue against its use, mainly citing unpredictable resorption as the purported disadvantage. However, it is less susceptible to infection, and results in fewer long-term complications than alloplastic materials. There is no alloplastic material that has matched these outcomes, and thus autogenous bone should be considered as the primary option for cranioplasty procedures.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
背景
自体骨常被视为颅骨成形术的金标准材料，但在寻找更简单的技术时，仍然继续使用同种异体颅骨成形术。尽管使用外来材料可以获得短期的成功，但这些患者的长期随访结果通常显示失败率增加，原因是暴露或迟发性感染。然而，自体骨移植物会整合和再血管化，因此比同种异体材料更能抵抗感染。
方法
这是对在 1975 年至 2018 年间由资深作者（S.A.W.）进行的全层缺损重建性颅骨成形术的所有患者进行的回顾性研究。所有手术均使用自体骨进行。
结果
154 名患者符合纳入本报告的标准。颅骨成形术是为先天性和继发性指征而进行的。115 名患者采用分体颅骨（74.7%），12 名患者采用肋骨移植（7.8%），10 名患者采用髂嵴移植（6.5%），17 名患者采用供体部位移植物的组合（11.0%）。在整个系列中，没有患者发生与供体部位或移植物感染相关的并发症。没有患者需要进行二次手术来填补术后吸收造成的缺陷。
结论
尽管自体骨被广泛认为是颅骨成形术的金标准材料，但有些人反对使用它，主要是因为认为其吸收不可预测是所谓的缺点。然而，它不易感染，并且比同种异体材料导致更少的长期并发症。没有任何一种同种异体材料能达到这些结果，因此自体骨应被视为颅骨成形术的主要选择。
临床问题/证据水平：治疗性，IV 级。
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