National United Engineering Laboratory for Biomedical Material Modification, Dezhou, China.
Tenth People's Hospital, Tongji University, Shanghai, China.
Br J Neurosurg. 2020 Aug;34(4):388-396. doi: 10.1080/02688697.2020.1742291. Epub 2020 Apr 1.
Meta-analysis to evaluate complications in the use of autogenous bone and bone substitutes and to compare bone substitutes, specifically HA, polyetheretherketone (PEEK) and titanium materials. Search of PubMed, Cochrane, Embase and Google scholar to identify all citations from 2010 to 2019 reporting complications regarding materials used in cranioplasty. 20 of 2266 articles met the inclusion criteria, including a total of 2913 patients. The odds of overall complication were significantly higher in the autogenous bone group ( = 214/644 procedures, 33.2%) than the bone substitute groups ( = 116/436 procedures, 26.7%, CI 1.29-2.35, < 0.05). In bone substitutes groups, there was no significant difference in overall complication rate between HA and Ti (OR, 1.2; 95% CI, 0.47-3.14, = 0.69). PEEK has lower overall complication rates (OR, 0.51; 95% CI, 0.30-0.87, = 0.01) and lower implant exposure rates (OR, 0.17; 95% CI, 0.06-0.53, = 0.002) than Ti, but there was no significant difference in infection rates and postoperative hematoma rates. Cranioplasty is associated with high overall complication rates with the use of autologous bone grafts compared with bone substitutes. PEEK has a relatively low overall complication rates in substitutes groups, but still high infection rates and postoperative hematoma rates. Thus, autologous bone grafts should only be used selectively, and prospective long-term studies are needed to further refine a better material in cranioplasty.
对使用自体骨和骨替代物的并发症进行荟萃分析，并比较骨替代物，特别是 HA、聚醚醚酮（PEEK）和钛材料。检索 PubMed、Cochrane、Embase 和 Google Scholar，以确定 2010 年至 2019 年期间报告有关颅骨修复术中使用材料并发症的所有引文。2266 篇文章中有 20 篇符合纳入标准，共纳入 2913 例患者。自体骨组（214/644 例，33.2%）总体并发症发生率明显高于骨替代物组（116/436 例，26.7%，CI 1.29-2.35， < 0.05）。在骨替代物组中，HA 和 Ti 之间总体并发症发生率无显著差异（OR，1.2；95%CI，0.47-3.14， = 0.69）。PEEK 的总体并发症发生率较低（OR，0.51；95%CI，0.30-0.87， = 0.01）和植入物暴露率较低（OR，0.17；95%CI，0.06-0.53， = 0.002），低于 Ti，但感染率和术后血肿率无显著差异。与使用骨替代物相比，自体骨移植的颅骨修复术总体并发症发生率较高。PEEK 在替代物组中总体并发症发生率较低，但感染率和术后血肿率仍较高。因此，自体骨移植物应选择性使用，需要前瞻性长期研究进一步优化颅骨修复材料。
