颅骨缺损修补材料应用的Meta分析  

A meta-analysis of repair materials used in cranioplasty

作　　者：陈智谦 穆雄铮 Chen Zhi-qian;Mu Xiong-zheng(Department of Plastic Surgery,Huashan Hospital of Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院整形外科,上海市200040

出　　处：《中国组织工程研究》2018年第30期4913-4920,共8页Chinese Journal of Tissue Engineering Research

基　　金：上海市申康医院发展中心新兴前沿技术项目(SHDC12014113)~~

摘　　要：背景:随着组织工程技术的日益发展,可供术者选择的颅骨修补材料种类也日渐丰富,但目前仍缺乏更高循证医学等级的研究来探究常见可选材料的术后不良反应的区别。目的:对目前常用的4种颅骨修补材料术后不良反应进行Meta分析并对最新修补方法及材料的应用和研究进展作一综述。方法:广泛查阅2012年1月至2017年8月相关文献,纳入随机对照试验及回顾性研究对4种常用材料(自体骨,预制/术中塑形钛网,聚甲基丙烯酸甲酯(polymethyl methacrylate,PMMA),聚醚醚酮(polyether-ether-ketone,PEEK)在颅骨修补后的不良反应进行Meta分析。结果与结论:在已发表的文献中共有11篇符合纳入标准,共包含常见4种材料的2 191个手术过程。Meta分析结果表明,总体来看人工合成材料术后不良反应显著少于自体骨(OR=0.336,95%CI:0.151-0.784,P=0.008),自体骨与PMMA修补相比术后吸收率较高(OR=0.034,95%CI:0.002-0.624,P=0.023),常需二次手术。术中塑形钛网术后材料暴露率较高,已逐渐被预制钛网取代;PMMA,PEEK和预制钛网术后不良反应差异无显著性意义。结果证实,在颅骨修补材料中,文中观察的3种人工定制材料的术后不良反应显著少于自体骨,而且自体骨有着较高的吸收风险并且来源有限,也限制了应用;术中塑形钛网由于术后暴露率高已较少使用;在PMMA,PEEK和预制钛网中无显著优势材料;因此,颅骨修补术时自体骨不建议首先考虑使用,文中的3种人工定制材料则可根据价格及术者习惯等综合考虑使用。BACKGROUND:With the development of tissue engineering technology,there are an increasing number of materials available for cranioplasty.However,there is still a lack of higher evidence-based research to explore the difference in postoperative complications of common materials.OBJECTIVE:To compare adverse events after cranioplasty with four commonly used materials and to present a review for the newest methods and materials for skull repair.METHODS:Relevant literatures published from January 2012 to August 2017 were extensively reviewed.We included and analyzed retrospective studies and randomized controlled trials concerning adverse events after repair with four commonly used materials,included concerning four commonly used materials,including polymethyl methacrylate(PMMA),polyether-ether-ketone(PEEK),custom-made/intraoperative titanium mesh,and autologous bone.RESULTS AND CONCLUSION:Eleven eligible papers from published literatures were enrolled,containing 2 191 surgical procedures involving the four materials mentioned above.According to the outcome of Meta-analysis,postoperative complications resulting from synthetic materials are significantly less than that of autologous bone(odds ratio(OR)=0.336,95%confidence interval(CI):0.151-0.784,P=0.008).The higher absorption of autologous bone compared with PMMA(OR=0.034,95%CI:0.002-0.624,P=0.023)often results in a second surgery.Intraoperative titanium mesh that causes a high rate of exposure has been gradually replaced by custom-made titanium mesh.PMMA,PEEK and custom-made titanium mesh have no statistical difference in postoperative complications.Moreover,these three kinds of artificial materials can induce less complications compared with the autologous bone that has limited use due to a high risk of absorption and limited sources.Intraoperative titanium mesh has been gradually eliminated due to the high exposure rate.Generally,the autologous bone is not the first choice for the cranioplasty,and artificial materials mentioned above can be used in combination with

关 键 词：颅骨修补术 颅骨去骨瓣减压术 聚甲基丙烯酸甲酯 聚醚醚酮 自体骨 组织工程骨材料 预制/术中塑形钛网 不良反应 META分析 组织工程 颅骨 手术后并发症 

分 类 号：R318[医药卫生—生物医学工程]