From the Division of Plastic and Reconstructive Surgery, Department of Surgery.
Greater Los Angeles VA Healthcare System.
Plast Reconstr Surg. 2024 Oct 1;154(4):757e-772e. doi: 10.1097/PRS.0000000000011093. Epub 2023 Sep 26.
Fresh autologous cranial bone graft has traditionally been regarded as the ideal cranioplasty material; however, long-term comparisons of outcomes with modern alloplastic materials are absent in the literature. The authors evaluated complications and failures among cranioplasties performed with fresh, heterotopic, cranial bone graft versus 3 common alloplastic materials.
Random-effects meta-analyses of logit-transformed proportions were performed on studies published between 1971 and 2021 to evaluate complications and failures of cranioplasties performed with fresh, autologous, heterotopic cranial bone; polyetheretherketone (PEEK); polymethylmethacrylate (PMMA); or titanium with a mean follow-up of 12 months or more. Generalized mixed model meta-regressions were performed to account for heterogeneity and to evaluate the contributions of moderators to outcomes variables.
A total of 1490 patients (mean age, 33.9 ± 10.8 years) were included. Pooled, all-cause complications were 6.2% for fresh, heterotopic, autologous cranial bone (95% CI, 2.1% to 17.0%; I2 = 55.0; P = 0.02), 18.5% for PEEK (95% CI, 14.0% to 24.0%; I2 = 0.0%; P = 0.58), 26.1% for titanium (95% CI, 18.7% to 35.1%; I2 = 60.6%; P < 0.01), and 28.4% for PMMA (95% CI, 12.9% to 51.5%; I2 = 88.5%; P < 0.01). Pooled all-cause failures were 2.2% for fresh autologous cranial bone (95% CI, 0.4% to 10.6%; I2 = 0.0%; P = 0.45), 6.3% for PEEK (95% CI, 3.2% to 12.3%; I2 = 15.5%; P = 0.31), 11.4% for titanium (95% CI, 6.7% to 18.8%; I2 = 60.8%; P < 0.01), and 12.7% for PMMA (95% CI, 6.9% to 22.0%; I2 = 64.8%; P < 0.01). Meta-regression models indicated that each alloplastic subtype significantly and independently predicted higher complications, whereas titanium and PMMA were significant predictors for all-cause failures compared with autologous bone. All 3 subtypes were predictive of higher cranioplasty failures secondary to infection compared with autologous bone.
Cranioplasties performed with fresh, autologous, heterotopic cranial bone grafts resulted in lower complication and failure rates compared with alloplastic materials.
新鲜自体颅骨移植物一直被认为是理想的颅骨修复材料；然而，目前文献中缺乏与现代同种异体材料进行长期效果比较的研究。作者评估了新鲜、异位自体颅骨移植物与 3 种常见同种异体材料行颅骨修补术的并发症和失败情况。
对 1971 年至 2021 年间发表的研究进行了对数转换比例的随机效应荟萃分析，以评估使用新鲜、自体、异位颅骨；聚醚醚酮（PEEK）；聚甲基丙烯酸甲酯（PMMA）；或钛行颅骨修补术的并发症和失败情况，平均随访时间为 12 个月或以上。广义混合模型荟萃回归用于解释异质性，并评估了各调节因素对结局变量的影响。
共纳入 1490 例患者（平均年龄 33.9 ± 10.8 岁）。所有原因并发症的总体发生率为新鲜、异位自体颅骨组 6.2%（95%CI，2.1%至 17.0%；I2=55.0；P=0.02），PEEK 组 18.5%（95%CI，14.0%至 24.0%；I2=0.0%；P=0.58），钛组 26.1%（95%CI，18.7%至 35.1%；I2=60.6%；P<0.01），PMMA 组 28.4%（95%CI，12.9%至 51.5%；I2=88.5%；P<0.01）。所有原因失败的总体发生率为新鲜自体颅骨组 2.2%（95%CI，0.4%至 10.6%；I2=0.0%；P=0.45），PEEK 组 6.3%（95%CI，3.2%至 12.3%；I2=15.5%；P=0.31），钛组 11.4%（95%CI，6.7%至 18.8%；I2=60.8%；P<0.01），PMMA 组 12.7%（95%CI，6.9%至 22.0%；I2=64.8%；P<0.01）。荟萃回归模型表明，每种同种异体亚型均显著且独立地预测更高的并发症发生率，而钛和 PMMA 与自体骨相比，是所有原因失败的显著预测因子。与自体骨相比，所有 3 种亚型均与感染引起的更高的颅骨修补失败率相关。
与同种异体材料相比，使用新鲜、自体、异位颅骨移植物行颅骨修补术的并发症和失败发生率更低。
