OMFS Department, Faculty of Dentistry, Cairo University, Cairo, Egypt.
OMFS Department, Faculty of Dentistry, Cairo University, Cairo, Egypt.
J Craniomaxillofac Surg. 2024 Nov;52(11):1299-1310. doi: 10.1016/j.jcms.2024.08.004. Epub 2024 Sep 5.
This prospective study aimed to compare ultra-high molecular weight polyethylene (UHMWPE) with polyetheretherketone (PEEK) in computer-designed patient-specific implants (PSIs) for cranial defect reconstruction, in terms of complications and aesthetic outcomes. Primary or secondary cranioplasty-eligible patients were included, while patients with active infection or hydrocephalus, or unfit for general anesthesia, were excluded from the study. All the implants were designed and fabricated by the same maxillofacial surgeon using CAD/CAM technology. UHMWPE PSIs were used in group 1 and PEEK PSIs in group 2. Technically, UHMWPE could be milled to a thinner margin thickness than PEEK, which resulted in better handling properties and a smoother end finish. All patients were evaluated over a period of 6 months in terms of overall complications or implant failure as the primary outcome, according to Clavien-Dindo (CVD) grading, and cosmetic satisfaction with the aesthetic results, using a Likert scale, as the secondary outcome. In total, 22 cranioplasty patients were included, with a mean age of 30.8 years (SD = 16.3). Across both groups, 17 patients (77.3%) did not develop postoperative complications. These occurred in three patients in group 1 (CVD grade I, II, and IIIb) (27.3%) and in two patients in group 2 (CVD grade II, IIIa, and IIIb) (18.2%), with no statistical difference (p = 0.6). None of the cases in both groups developed any clinical or radiographic signs of infection, or suffered implant failure. The mean satisfaction score was 4.8 in group 1 and 4.5 in group 2 (SD = 0.6). The difference in satisfaction scores between the two was not statistically significant (p = 0.23). Although UHMWPEE was comparable to PEEK in terms of overall complication rates and cosmesis after craniectomy, UHMWPEE as a material exhibited greater resiliency in technically challenging cases with large, complex/midline-crossing designs, previously fitted meshes, or single-stage resection-reconstruction, allowing better marginal adaptation.
本前瞻性研究旨在比较超高分子量聚乙烯（UHMWPE）和聚醚醚酮（PEEK）在计算机设计的患者特异性植入物（PSI）用于颅缺损重建方面的并发症和美容效果。纳入原发性或继发性颅骨修复术合格的患者，而排除有活动性感染或脑积水的患者，或不适合全身麻醉的患者。所有植入物均由同一位颌面外科医生使用 CAD/CAM 技术设计和制造。UHMWPE PSI 用于第 1 组，PEEK PSI 用于第 2 组。从技术上讲，UHMWPE 可以铣削到比 PEEK 更薄的边缘厚度，从而具有更好的处理性能和更光滑的末端光洁度。所有患者在 6 个月的时间内根据 Clavien-Dindo（CVD）分级评估总体并发症或植入物失败作为主要结局，根据 Likert 量表评估美容满意度作为次要结局。共有 22 例颅骨修复术患者纳入研究，平均年龄为 30.8 岁（SD=16.3）。在两组中，17 例患者（77.3%）未发生术后并发症。这些并发症发生在第 1 组的 3 例患者（CVD 1 级、2 级和 3b 级）（27.3%）和第 2 组的 2 例患者（CVD 2 级、3a 级和 3b 级）（18.2%），差异无统计学意义（p=0.6）。两组均未发生任何临床或影像学感染迹象或植入物失败。第 1 组的平均满意度评分为 4.8，第 2 组为 4.5（SD=0.6）。两组之间的满意度评分差异无统计学意义（p=0.23）。虽然 UHMWPE 在总体并发症发生率和颅骨切除术美容效果方面与 PEEK 相当，但在技术挑战性较大的病例中，UHMWPE 作为一种材料具有更大的弹性，例如具有较大、复杂/中线交叉设计、先前适配的网片或单阶段切除-重建的病例，允许更好的边缘适配。
