聚醚醚酮及钛网用于颅骨修补术后并发症及危险因素分析  

Analysis of complications and risk factors of cranioplasty with polyetheretherketone and titanium mesh

作　　者：姚舜[1,2] 黎依琳 张祺愉 唐雅彬 麦益颖 杨宏毅 张润 YAO Shun;LI Yilin;ZHANG Qiyu;TANG Yabin;MAI Yiying;YANG Hongyi;ZHANG Run(Second Clinical Medical College of Southern Medical University,Guangzhou 510282,China;Shanghai Medical College,Fudan University,Shanghai 200032,China;Zhujiang Hospital,Southern Medical University/Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration,Guangzhou 510282,China)

机构地区：[1]南方医科大学第二临床医学院,广东广州510282 [2]复旦大学上海医学院,上海200032 [3]南方医科大学珠江医院广东省脑功能修复与再生重点实验室,广东广州510282

出　　处：《中国实用神经疾病杂志》2021年第18期1565-1574,共10页Chinese Journal of Practical Nervous Diseases

基　　金：国家自然科学基金(编号:81701200)。

摘　　要：目的分析以聚醚醚酮(polyetheretherketone,PEEK)、钛网为材料行颅骨修补术后并发症发生率及相关危险因素。方法回顾分析南方医科大学珠江医院神经外科2017-07—2020-09以PEEK及钛网行颅骨修补术的181例患者早期并发症,随访并观察远期效果,采用多因素Logistic回归模型分析并发症相关危险因素。结果PEEK组与钛网组总并发症发生率分别为57.5%与66.7%,差异无统计学意义(P>0.05),远期并发症率分别为25.3%与31.1%,差异无统计学意义(P>0.05)。钛网组早期颅内积气、硬膜外积液、远期皮下积液发生率显著高于PEEK组。Logistic回归分析显示,早期修补(P=0.037)是总体并发症的危险因素,感染(P<0.001)是术后修补失败危险因素,凹陷性颅骨缺损(P=0.043)增加术后积气的发生率,脑室-腹腔分流术增加早期皮下积液发生率(P=0.012),修补材料为远期皮下积液危险因素(P=0.037)。结论PEEK修补术后总体并发症发生率与钛网相比无显著差异,但早期硬膜外积液、积气及远期皮下积液发生率显著降低。早期修补是总并发症的危险因素,修补前应及时调整颅内压缓解皮瓣凹陷性颅骨缺损,应监测调整脑室、腹腔引流量。术中严密缝合硬膜防止颅内积气,修补术后应积极给予抗感染治疗避免二次手术。Objective To analyze the incidence of complications and related risk factors after cranioplasty with polyetheretherketone(PEEK)and titanium mesh.Methods The early complications of 181 patients underwent skull repair with PEEK and titanium mesh in the Department of Neurosurgery of Zhujiang Hospital of Southern Medical University from July 2017 to September 2020 were analyzed retrospectively. Multivariate Logistic regression model was used to analyze the risk factors of early and late complications.Results The total complication rates of PEEK group and titanium mesh group were 57.5% and 66.7%,respectively,the difference was not statistically significant(P>0.05),and the long-term complication rates were 25.3% and 31.1%,respectively,the difference was not statistically significant(P>0.05). The incidence of early intracranial pneumatosis,epidural effusion and long-term subcutaneous effusion in titanium mesh group was significantly higher than that in PEEK group. Logistic regression analysis showed that early repair(P=0.037)was the risk factor of overall complications,infection was the risk factor of postoperative repair failure(P<0.001),depressed skull defect(P=0.043)increased the incidence of postoperative pneumatosis,ventriculoperitoneal shunt increased the incidence of early subcutaneous effusion(P=0.012),as well the repair material was the risk factor of long-term subcutaneous effusion(P=0.037).Conclusion There is no significant difference in the overall incidence of complications between PEEK and titanium mesh,but the incidence of early epidural effusion,pneumatosis and long-term subcutaneous effusion far below that of titanium mesh. Early cranioplasty is the risk factor of the total complications. Before repair,intracranial pressure should be adjusted in time to relieve the depressed skull defect of skin flap.The same time,ventriculoperitoneal drainage should be monitored and perioperative nursing should be paid attention. During the operation,the dura mater should be sutured tightly to prevent intracranial pneu

关 键 词：颅骨修补 聚醚醚酮 钛网 并发症 危险因素 

分 类 号：R651.11[医药卫生—外科学]