He Zhenghui, Ma Yuxiao, Yang Chun, Hui Jiyuan, Mao Qing, Gao Guoyi, Jiang Jiyao, Feng Junfeng
Brain Injury Center, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Shanghai Institute of Head Trauma, Shanghai, China.
Front Surg. 2022 Mar 21;9:856743. doi: 10.3389/fsurg.2022.856743. eCollection 2022.
At present, lots of studies have discussed the effects and outcomes of cranioplasty using polyetheretherketone (PEEK). However, interventions or management for PEEK cranioplasty got less attention. This article presented a perioperative paradigm for preventing postoperative complications.
Modified PEEK plates with certified safety were implanted in patients who received evolving perioperative paradigm. Serial perioperative managements were developed as a comprehensive paradigm to prevent correlated risk factors of postoperative complications, which mainly included managements of epidural collections and wound healing. The preparation of the surgical area and systemic state were essential before surgery. During the operation, the blood supply of the incision and the handling of dura and temporalis were highlighted in our paradigm. After cranioplasty, management of subcutaneous drainage and wound healing were stressed. Patients received conventional management from February 2017 to August 2018 in our center. After the evolving paradigm developed, patients received comprehensive perioperative management from September 2018 to August 2020.
A total of 104 patients who underwent PEEK cranioplasty were consecutively enrolled; 38 (36.5%) received conventional perioperative management, and 66 (63.5%) received evolving perioperative paradigm. The general information of the two groups was comparable. Notably, patients who received the evolving paradigm presented a significantly decreased incidence of postoperative complications from 47.4 to 18.2% ( < 0.01), among which the incidences of subcutaneous effusion, epidural hematoma, and subcutaneous infection decreased significantly.
The evolving perioperative paradigm could effectively prevent risk factors and reduce related complications. It was valuable to promote these comprehensive managements and inspire more clinical practice on improving patients' outcomes after PEEK cranioplasty.
目前，许多研究探讨了使用聚醚醚酮（PEEK）进行颅骨修补术的效果和结果。然而，针对PEEK颅骨修补术的干预措施或管理受到的关注较少。本文提出了一种预防术后并发症的围手术期模式。
将具有认证安全性的改良PEEK板植入接受不断发展的围手术期模式的患者体内。制定了一系列围手术期管理措施作为一种综合模式，以预防术后并发症的相关风险因素，主要包括硬膜外积液和伤口愈合的管理。手术区域的准备和全身状态在手术前至关重要。在手术过程中，我们的模式强调切口的血供以及硬脑膜和颞肌的处理。颅骨修补术后，强调皮下引流和伤口愈合的管理。2017年2月至2018年8月，我们中心的患者接受传统管理。在不断发展的模式形成后，2018年9月至2020年8月的患者接受了全面的围手术期管理。
连续纳入104例行PEEK颅骨修补术的患者；38例（36.5%）接受传统围手术期管理，66例（63.5%）接受不断发展的围手术期模式。两组的一般信息具有可比性。值得注意的是，接受不断发展模式的患者术后并发症发生率从47.4%显著降至18.2%（P<0.01），其中皮下积液、硬膜外血肿和皮下感染的发生率显著降低。
不断发展的围手术期模式可以有效预防风险因素并减少相关并发症。推广这些综合管理措施并激发更多关于改善PEEK颅骨修补术后患者结局的临床实践具有重要价值。
