三维塑形材料用于颅骨缺损修复的有效性和安全性的长期随访分析

Long-term follow-up analysis of the efficacy and safety of three - dimensional shaping materials for the repair of cranial defects

摘要:

目的 探究三维塑形材料在颅骨缺损修复中的有效性及安全性。方法 回顾性分析我院使用三维塑形材料进行颅骨修复术的100例患者的临床资料。修复材料相关并发症定义为植入物断裂或外露。按是否发生修复材料相关并发症，分为无并发症组和并发症组。脑外伤患者预后评价采用格拉斯哥预后评分（Glasgow outcome sclae，GOS），脑出血患者预后评价采用改良Rankin评分（modified Rankin scale, mRS）。所有患者手术时间均超过五年，入组后进行电话随访，收集患者对颅骨修复后外形和功能恢复的满意度。结果 100例患者中，12例发现并发症，占12.0%，主要发生在颅骨修复术后1年内（占75.0%）。单因素分析发现糖尿病，颅骨切除术病因，修复材料种类和术中剥离颞肌与并发症的发生有关（p＜0.05）。颅骨修复术显著改善患者近期和远期预后（均p＜0.01）。65.0%患者对修复材料外形满意，31.0%患者基本满意，4%患者不满意。48.0%患者对颅骨修复手术后功能恢复非常满意，43.0%基本满意，9.0%不满意。结论 长期随访研究发现，三维塑形材料用于颅骨缺损修复手术有效性好，安全性高，但是修复材料相关并发症仍需引起术者重视。

关键词:三维塑形颅骨修复材料;颅骨缺损修复;有效性;安全性;随访

Abstract:

Objective To investigate the effectiveness and safety of cranioplasty by using three-dimensional molding materials.Methods The clinical data of 100 patients who underwent cranioplasty by using three-dimensional molding materials in our hospital were retrospectively analyzed.Material-related complications were defined as implant fracture or exposure.The patients were categorized into none-complication group and complication group according to the occurrence of material-related complication. The prognosis of patients with traumatic brain injury was evaluated using the Glasgow Outcome Scale (GOS), and the prognosis of patients with cerebral hemorrhage was evaluated using the Modified Rankin Scale (mRS). The operation time of all patients exceeded five years. After enrollment, telephone follow - up was conducted to collect patients' satisfaction with the restoration of cranial shape and functional recovery after cranioplasty.Results Among 100 patients, material-related complications were found in 12 cases(12.0%), mainly occurring within 1 year after cranioplasty （75.0%）. Univariate analysis found that diabetes mellitus, craniectomy for brain injury or cerebral hemorrhage, material for cranioplasty and intraoperative treatment of temporal muscle were associated with the development of complications (all p< 0.05). Craniectomy significantly improved the short- and long-term prognosis (both p < 0.01). Sixty-five percentage of the patients were satisfied with the profile of the cranial, 31.0% of the patients were mostly satisfied and 4% of the patients were dissatisfied. In addition, 48.0% of the patients were very satisfied with neurological recovery after craniectomy, 43.0% were mostly satisfied and 9.0% were dissatisfied. Conclusion According to the long-term follow-up, we found that three-dimensional molding material displays a more effective and safe result for cranioplasty. The material-related complications should be paid more attention during cranioplasty by the neurosurgeon.

Key words:three-dimensional molding material; cranioplasty; effectiveness; safety; follow-up