中国组织工程研究

中国组织工程研究 ›› 2022, Vol. 26 ›› Issue (21): 3327-3331.doi: 10.12307/2022.639

• 组织工程神经材料 tissue-engineered nerve materials • 上一篇    下一篇

3D打印数字化塑形聚醚醚酮和钛网颅骨修补后并发症异同和应用改进

胡均贤1，赵德英1，王  雷1，黄明火1，吴雅兰1，陈劲草1，刘  征2   

  1. 1长江大学附属黄冈市中心医院，湖北省黄冈市  438000；2武汉大学中南医院，湖北省武汉市  430000
  • 收稿日期:2021-09-06 接受日期:2021-10-28 出版日期:2022-07-28 发布日期:2022-01-27
  • 通讯作者: 刘征，副主任医师，武汉大学中南医院，湖北省武汉市 430000
  • 作者简介:胡均贤，男，1983年生，湖北省黄冈市人，汉族，2010年西南医科大学毕业，硕士，主治医师，主要从事颅脑损伤和脑血管病方面的研究。

Complication comparison and application improvement of 3D-printed plastic polyetherketone and titanium mesh cranioplasty

Hu Junxian1, Zhao Deying1, Wang Lei1, Huang Minghuo1, Wu Yalan1, Chen Jincao1, Liu Zheng2   

  1. 1Huanggang Central Hospital of Yangtze University, Huanggang 438000, Hubei Province, China; 2Zhongnan Hospital, Wuhan University, Wuhan 430000, Hubei Province, China
  • Received:2021-09-06 Accepted:2021-10-28 Online:2022-07-28 Published:2022-01-27
  • Contact: Liu Zheng, Associate chief physician, Zhongnan Hospital, Wuhan University, Wuhan 430000, Hubei Province, China
  • About author:Hu Junxian, Master, Attending physician, Huanggang Central Hospital of Yangtze University, Huanggang 438000, Hubei Province, China

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摘要：

文题释义：
颅骨修补材料：除自体材料外，人工材料在不断地更新，早期应用于临床的材料如有机玻璃、硅橡胶和骨水泥等由于各种缺陷已经被淘汰，目前人工材料中的金属材料以钛网最为常用，非金属材料以聚醚醚酮最为常用，这两种材料有各自的优缺点，影响着手术预后。
颅骨修补术后并发症：与手术相关的并发症如颅内血肿和颅内感染等，随着外科手术技术的成熟，其发生率在逐步下降。而不同修补材料的物理特性可以影响术后并发症的发生率，因此，如何降低并发症发生率和明确修补材料的改进方向很重要。

背景：颅骨修补材料种类繁多，但目前仍然没有哪种材料能在生物相容性、性价比等各方面性能上全部满足临床需要。
目的：分析3D打印数字化塑形聚醚醚酮和钛网修补颅骨缺损的术后并发症差异，针对并发症明确改进方向。
方法：回顾性分析长江大学附属黄冈市中心医院2014年6月至2021年6月收治的207例颅骨缺损患者，男157例，女50例，年龄16-68岁，其中42例使用聚醚醚酮修补材料，165例使用钛网修补材料。术后第3周，进行额颞顶区缺损区塑形满意度调查；术后随访统计并发症发生情况。
结果与结论：①聚醚醚酮组32例进行额颞顶区缺损修补，塑形满意度为56.3%；钛网组117例进行额颞顶区缺损修补，塑形满意度为75.2%，两组塑形满意度比较差异有显著性意义(P < 0.05)；②聚醚醚酮组42例中14例发生并发症，其中皮下积液12例(28.6%)、癫痫1例、额部螺钉固定处隆起疼痛1例，并发症发生率为33.3%；钛网组165例中28例发生并发症，其中皮下积液15例(9.1%)、癫痫7例、颅内感染2例、材料外露2例、颅内血肿1例、材料松动1例，并发症发生率为17.0%，两组间皮下积液及总并发症发生率比较差异有显著性意义(P < 0.05)；③结果表明，额颞顶区骨质缺损处采用钛网修补较聚醚醚酮材料修补美观、满意度更高，聚醚醚酮材料应用于颅骨修补的主要改进方向是降低术后皮下积液的发生率。

https://orcid.org/0000-0003-1048-8380 (胡均贤) 

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程

关键词: 生物材料, 聚醚醚酮, 钛网, 颅骨修补, 颅骨缺损, 数字化塑形技术, 并发症

Abstract: BACKGROUND: There are many kinds of skull repair materials, but there is still no one material in high biocompatibility, high cost-effective and low incidence of complications in all aspects of clinical needs. 
OBJECTIVE: To analyze the difference in postoperative complications of 3D printed plastic polyetherketone and titanium mesh cranioplasty, and point out the improvement directions.
METHODS: Data of 207 patients undergoing cranioplasty in Huanggang Central Hospital of Yangtze University from June 2014 to June 2021 were retrospectively analyzed, including 157 males and 50 females, at the age of 16-68 years old. Among them, 42 patients were treated with polyetheretherketone and 165 patients were treated with titanium mesh. The satisfaction survey of the reconstruction of the frontotemporal parietal defect area was carried out at 3 weeks after the operation. Complications were analyzed during postoperative follow-up.  
RESULTS AND CONCLUSION: (1) There were 32 cases of skull defect repaired with polyetheretherketone, with shaping satisfaction of 56.3%, and 117 cases of skull defect repaired with titanium mesh, with shaping satisfaction of 75.2%. Significant differences in shaping satisfaction were found between the two groups (P < 0.05). (2) Complications occurred in 14 of 42 cases in the polyetheretherketone group, including 12 cases of subcutaneous hydrops (28.6%), 1 case of epilepsy, and 1 case of forehead screw fixation swelling pain; with a complication rate of 33.3%. Among the 165 cases in the titanium mesh group, 28 cases had complications, including 15 cases of subcutaneous hydrops (9.1%), 7 cases of epilepsy, 2 cases of intracranial infection, 2 cases of material exposure, 1 case of intracranial hematoma, 1 case of material loosening, with a complications rate of 17.0%. There was a significant difference in the incidence of subcutaneous hydrops and total complication rate between the two groups (P < 0.05). (3) It is concluded that titanium mesh was better than polyetherketone mesh in repairing bone defect of frontotemporal parietal region, with a high satisfaction. The main improvement direction of polyetheretherketone in cranioplasty is to reduce the incidence of postoperative subcutaneous hydrops. 

Key words: biomaterial, polyetherketone, titanium mesh, skull repair, skull defect, digital shaping technique, complications

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