聚醚醚酮与钛网在去骨瓣减压术后颅骨成形术中临床应用效果的单中心回顾性研究  

Clinical outcomes of custom-designed polyetheretherketone and titanium in cranioplasty after decompressive craniectomy： a single center study

作　　者：孙新林[1] 王继辉 黄敏[1] 金法[1] 黄柒金[1] 柯以铨[1] Sun Xinlin;Wang Jihui;Huang Min;Jin Fa;Huang Qijin;Ke Yiquan(National Key Clinical Specialty,Guangdong Provincial Clinical Research Center of Neurosurgery,Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration,Department of Neurosurgery,Zhujiang Hospital,Southern Medical University,Guangzhou 510282,China)

机构地区：[1]国家临床重点专科、广东省神经外科临床研究中心、广东省脑功能修复与再生重点实验室、南方医科大学珠江医院神经外科,广州510282

出　　处：《中华神经医学杂志》2018年第8期825-830,共6页Chinese Journal of Neuromedicine

基　　金：国家自然科学基金面上项目（81772652）;广东省神经外科临床医学研究中心（20138020400005）

摘　　要：目的比较聚醚醚酮（PEEK）和钛网在去骨瓣减压术后颅骨成形术中的临床应用效果。方法选择南方医科大学珠江医院神经外科同一诊疗组自2014年6月至2017年12月收治的去骨瓣减压术后行颅骨成形术的86例颅骨缺损患者，其中应用PEEK材料行颅骨成形术28例（PEEK组），应用钛网材料行颅骨成形术58例（钛网组）。比较2组患者的一般临床资料及术后并发症的发生情况，并采用多因素Logistic回归分析模型分析颅骨成形术后并发症发生的影响因素：比较2组患者的手术时间、塑形效果及治疗费用。结果与钛网组比较，PEEK组患者的年龄较小，颅骨成形术前格拉斯哥预后评分（GOS）较高，差异有统计学意义（P〈0．05）。PEEK组患者并发症发生率明显小于钛网组，差异有统计学意义（P〈0．05）；多因素Logistic回归分析显示修补材料是颅骨成形术后并发症发生的独立影响因素（OR=4．486，P=-0．047，95％CI：1．021～19．703）。PEEK组患者的平均住院费用高于钛网组，差异有统计学意义（P〈0．05）；PEEK组患者对颅骨成形术的塑形满意率高于钛网组患者（96．4％vs．79.3％），差异有统计学意义（P〈0．05）。结论与钛网比较，去骨瓣减压术后应用PEEK行颅骨成形术具有并发症少、塑形效果更好等优点，但其费用高，可作为颅骨成形术的备选材料。Objective To compare the clinical outcomes and complications of alloplastic cranioplasty performed with custom-designed polyetheretherketone （PEEK） and titanium mesh after decompressive craniectomy. Methods Eighty-six patients admitted to our hospital fi＇om June 2014 to December 2017 were chosen; and 28 patients underwent cranioplasty with PEEK and 58 with titanium mesh by the same surgical team. The general clinical data and postoperative complications were compared between the two groups. Multivariable Logistic regression analysis was performed to analyze the influencing factors of postoperative complications. The surgical time, molding quality and cost were compared between the two groups. Results Patients in PEEK group trended to be younger and had higher GOS scores as compared with patients in the titanium group, with significant differences （P〈0.05）. Overall complication rates of 10.7% and 32.8% for PEEK and titanium cranioplasty were identified respectively; as compared with that in titanium group, the incidence of overall complication in PEEK group was significant lower （P〈0.05）. Logistic regression analysis identified material was the independent influencing factor for cranioplasty complications （OR=4.486, P=0.047, 95%CI： 1.021-19.703）. Overall satisfaction rate with cranioplasty and aesthetic result in PEEK group was significantly higher than that in titanium group （96.4% vs. 79.3%, P〈0.05）; however, the treatment cost for cranioplasty with PEEK was considerably higher than skull bone reconstruction based on titanium mesh. Conclusion Despite of high treatment cost, custom-designed PEEK implants seem to be good choice for patients with large cranial defects after decompressive craniectomy, enjoying few complications and high satisfaction of cranioplasty and aesthetic result.

关 键 词：颅骨成形术 去骨瓣减压术 聚醚醚酮 钛网 并发症 

分 类 号：R651.11[医药卫生—外科学]