National Neurosurgical Centre, Beaumont Hospital, Dublin, Ireland.
School of Medicine, University College Dublin, Belfield, Dublin, Ireland.
Neurosurgery. 2021 Aug 16;89(3):383-394. doi: 10.1093/neuros/nyab180.
Cranioplasty is a ubiquitous neurosurgical procedure consisting of reconstruction of a pre-existing calvarial defect. Many materials are available, including polymethylmethacrylate in hand-moulded (hPMMA) and prefabricated (pPMMA) form, hydroxyapatite (HA), polyetheretherketone (PEEK) and titanium (Ti).
To perform a network meta-analysis (NMA) to assess the relationship between materials and complications of cranioplasty.
PubMed/MEDLINE, Google Scholar, EMBASE, Scopus, and The Cochrane Library were searched from January 1, 1990 to February 14, 2021. Studies detailing rates of any of infections, implant exposure, or revision surgery were included. A frequentist NMA was performed for each complication. Risk ratios (RRs) with 95% CIs were calculated for each material pair.
A total of 3620 abstracts were screened and 31 full papers were included. Surgical revision was reported in 18 studies and occurred in 316/2032 cases (14%; 95% CI 11-17). PEEK had the lowest risk of re-operation with a rate of 8/157 (5%; 95% CI 0-11) in 5 studies, superior to autografts (RR 0.20; 95% CI 0.07-0.57), hPMMA (RR 0.20; 95% CI 0.07-0.60), Ti (RR 0.39; 95% CI 0.17-0.92), and pPMMA (RR 0.14; 95% CI 0.04-0.51). Revision rate was 131/684 (19%; 95% CI 13-25; 10 studies) in autografts, 61/317 (18%; 95%CI 9-28; 7 studies) in hPMMA, 84/599 (13%; 95% CI 7-19; 11 studies) in Ti, 7/59 (9%; 95% CI 1-23; 3 studies) in pPMMA, and 25/216 (12%; 95% CI 4-24; 4 studies) in HA. Infection occurred in 463/4667 (8%; 95% CI 6-11) and implant exposure in 120/1651 (6%; 95% CI 4-9).
PEEK appears to have the lowest risk of cranioplasty revision, but further research is required to determine the optimal material.
颅骨修复术是一种普遍的神经外科手术，包括重建先前存在的颅骨缺损。有许多材料可供选择，包括手塑型（hPMMA）和预制型（pPMMA）聚甲基丙烯酸甲酯、羟基磷灰石（HA）、聚醚醚酮（PEEK）和钛（Ti）。
进行网络荟萃分析（NMA）以评估颅骨修复术材料与并发症之间的关系。
从 1990 年 1 月 1 日至 2021 年 2 月 14 日，检索了 PubMed/MEDLINE、Google Scholar、EMBASE、Scopus 和 The Cochrane Library。纳入详细报告任何感染、植入物暴露或翻修手术发生率的研究。对每种并发症均进行了频率派 NMA。计算了每对材料的风险比（RR）及其 95%置信区间（CI）。
共筛选出 3620 篇摘要，纳入 31 篇全文。18 项研究报告了手术翻修，2032 例病例中有 316 例（14%；95%CI 11-17）发生。5 项研究中，PEEK 的再手术风险最低，157 例中有 8 例（5%；95%CI 0-11），优于自体移植物（RR 0.20；95%CI 0.07-0.57）、hPMMA（RR 0.20；95%CI 0.07-0.60）、Ti（RR 0.39；95%CI 0.17-0.92）和 pPMMA（RR 0.14；95%CI 0.04-0.51）。自体移植物的翻修率为 131/684（19%；95%CI 13-25；10 项研究），hPMMA 为 61/317（18%；95%CI 9-28；7 项研究），Ti 为 84/599（13%；95%CI 7-19；11 项研究），pPMMA 为 7/59（9%；95%CI 1-23；3 项研究），HA 为 25/216（12%；95%CI 4-24；4 项研究）。463/4667（8%；95%CI 6-11）例发生感染，120/1651（6%；95%CI 4-9）例发生植入物暴露。
PEEK 似乎具有最低的颅骨修复术翻修风险，但需要进一步研究以确定最佳材料。
