From the UAB School of Medicine.
UAB Division of Plastic Surgery.
Ann Plast Surg. 2022 Jun 1;88(5 Suppl 5):S449-S454. doi: 10.1097/SAP.0000000000003019. Epub 2021 Oct 8.
Although the literature contains reports of the risks and complications of calvarial vault reconstruction for acquired defects, there are few publications addressing the specific patient population who require such reconstructions in cases preceded by prior infection, radiation, massive associated soft tissue trauma, and so on. We define such clinical presentations as a hostile environment for large surface area reconstruction. Our objective is to compare the safety and efficacy of autologous bone and alloplastic reconstruction in hostile cranial defects.
An institutional review board-approved retrospective review of patients who underwent cranioplasty of a hostile site at the University of Alabama at Birmingham between January 2008 and December 2018 was performed. The patients were stratified into 3 groups based on the type of implant used: autogenous (bone), alloplastic (polyetheretherketone [PEEK], titanium, polymethyl methacrylate), or mixed (combination of bone and prosthetic). The primary outcome metric was a complication in the year after cranioplasty, identified by implant failure, necrosis, or infection. Statistical analysis included t tests and χ2 tests where appropriate using SPSS.
There were 55 total cases in this period: 27 autogenous, 23 alloplastic, and 5 mixed. The purely autogenous group had the highest complication rate (44%), and the alloplastic group had the lowest complication rate (38%), which was not statistically different between the 3 groups (P = 0.121). When stratified by specific material used for reconstruction (27 bone, 14 PEEK, 10 titanium, and 5 polymethyl methacrylate), overall complication rate was statistically significant (P = 0.009, χ2 test), with PEEK implants having the lowest complication rate (21%).
This analysis interestingly found that in the setting of hostile cranial defects, cranioplasties would benefit from the use of prosthetic implants instead of autologous bone grafts, not only for avoidance of donor site morbidity but also for a decrease in overall complications.
尽管文献中已有关于颅骨重建术用于治疗获得性缺损的风险和并发症的报道，但很少有文献针对需要进行大面积重建的特定患者群体进行报道，这些患者先前存在感染、放疗、大量相关软组织创伤等情况。我们将此类临床表现定义为大面积重建的恶劣环境。我们的目的是比较自体骨和同种异体重建在恶劣颅缺损中的安全性和有效性。
对 2008 年 1 月至 2018 年 12 月在阿拉巴马大学伯明翰分校接受恶劣部位颅骨修复术的患者进行了机构审查委员会批准的回顾性研究。根据使用的植入物类型，将患者分为 3 组：自体（骨）、同种异体（聚醚醚酮[PEEK]、钛、聚甲基丙烯酸甲酯）或混合（骨和假体的组合）。主要结局指标是颅骨修复术后 1 年内的并发症，包括植入物失败、坏死或感染。统计分析包括 t 检验和 χ2 检验，适当情况下使用 SPSS 进行分析。
在此期间共有 55 例患者：27 例自体，23 例同种异体，5 例混合。单纯自体组的并发症发生率最高（44%），同种异体组的并发症发生率最低（38%），3 组之间的差异无统计学意义（P=0.121）。按重建使用的具体材料（27 例骨、14 例 PEEK、10 例钛、5 例聚甲基丙烯酸甲酯）进行分层，总体并发症发生率有统计学意义（P=0.009，χ2 检验），其中 PEEK 植入物的并发症发生率最低（21%）。
本分析有趣地发现，在恶劣的颅缺损环境中，颅骨修复术受益于使用假体植入物而不是自体骨移植物，不仅可以避免供体部位发病率，还可以降低总体并发症发生率。
