A Series Of Studies On The Comparison Of Cranioplasty Materials

Objective:Through single center data and META analysis,the safety of autologous skull and different artificial cranioplasty materials were compared,and the application of cranioplasty materials in a certain area was investigated,suggestions on the selection of cranioplasty materials are put forward.Content:1.To analyze the cranioplasty failure cases,explore the causes and the characteristics of failures with different cranioplasty materials,and put forward the corresponding countermeasures.2.To analyze the number and trend of cranioplasty cases with different cranioplasty materials in single center,compare the safety of cranioplasty with autologous skull and artificial materials,and guide the selection of cranioplasty materials.3.By investigating the current situation of cranioplasty materials used in major neurosurgical centers in Shandong province,this paper analyzed the status of different cranioplasty materials,analyzed the situation and changing trend of the materials used,and puts forward suggestions on the preservation of autologous skull and the selection of cranioplasty materials.4.The available literatures were reviewed systematically to compare the complications and failure rates of the most commonly used autologous skull,titanium mesh and polyether-ether-ketone as cranioplasty materials,and to evaluate the safety of autologous skull and artificial materials.Methods1.Retrospective and prospective research analyses were carried out between January 2011 and December 2018 in our center,fifty cranioplasty failure patients were screened.The causes that led to cranioplasty failures and characteristics of different materials were analyzed.2.Through neurosurgical database between January 2011 and December 2018,data of traumatic cranioplasty surgery was obtained.Patients were followed up continuously,to compare postoperative complications.Cranioplasty failure and reoperation during follow-up were used as comparative indexes,the safety of autologous cranioplasty was compared with that of artificial materials.3.A total of 22 grade A hospitals in 16 cities in Shandong province were investigated to analyze the amount of cranioplasty with various materials from 2013 to 2018,and to show the changing trend of different cranioplasty materials with statistical charts.4.The databases were retrieved and the most commonly used cranioplasty materials in the former investigation were included in the randomized controlled study and retrospective controlled study on the treatment of skull defects.Literature screening,data extracting and literature quality analyzing were completed,the complications and surgical failures of different cranioplasty materials were compared to show the safety of different cranioplasty materials.Results1.In all 50 cranioplasty failure patients,autologous bones were used in 28 cases,artificial materials were applied in 22 cases.Infection was the main cause of cranioplasty failure(35/50).In early stage(3 months)after surgery,autologous cranioplasty infections(16/19)appeared more than artificial skull material infections(2/16)(P< 0.05).Autograft infection culture positive rate(80%)was higher than artificial materials(33.33%),(P< 0.05).The proportion of hemorrhagic complications in titanium mesh cranioplasty group(6/22)was higher than that in autogenous skull cranioplasty group(1/28).(P< 0.05).2.Between January 2011 and December 2018,there were 1116 cranioplasty procedures in our center.During follow-up,there were 38 cases(3.41%)occurred cranioplasty failures.There was no significant difference in the failure rate of three kinds of cranioplasty materials(P > 0.05).The infection rate of autologous cranioplasty(2.11%)was higher than that of titanium mesh(1.77%),but there was no significant difference(P > 0.05).The incidence of bleeding(0.13%)was lower than that of titanium mesh(1.48%)which was statistical significance(P < 0.05).The infection of autogenous cranioplasty mostly occurred in the early stage after operation,and the infection of artificial materials mostly occurred in the late stage after operation,there was statistical significance(P<0.05).3.At present,cranioplasty materials used in Shandong province include: titanium mesh,autologous bone,bone cement composite and polyether-ether-ketone.Among the 22 units surveyed,11 provided titanium mesh cranioplasty,6 provided two kinds of cranioplasty materials,and 5 provided three kinds of cranioplasty materials.Of the 22 units surveyed,autologous skulls was still in use in 5 units,and early cranioplasty was underwent more than half(10/19).In the surveyed period,the ratio of autologous skull decreased from 22.52% in 2013 to 14.28% in 2018,and the ratio of titanium mesh increased from 74.59% in 2013 to 81.19% in 2018.The utilization rate of bone cement composites has been low.PEEK materials began to be popularized and applied in 2017,and the number of application cases increased rapidly and the proportion gradually increased.4.A total of 13 studies and 2204 patients were included in the meta-analysis.The failure rate of autologous skull and artificial material cranioplasty was highest due to infection.The results of Meta-analysis showed that there was no significant difference in postoperative complications and failure rate between autologous and artificial materials(P > 0.05).There was no significant difference in postoperative infection,subdural effusion,hemorrhage,epilepsy and other major complications between autologous and artificial materials(P > 0.05).There was no significant difference between the titanium mesh and PEEK in the incidence of total complications and cranioplasty failure,neither in the infection rate(P > 0.05).Conclusions1.The main cause of cranioplasty failure in autologous and artificial skull was infection;Autologous cranioplasty infections appeared earlier,and artificial skull infections occur more in the late stage of surgery.2.Single center case-control study showed that the safety of autologous skull was similar to that of artificial material,so autologous skull can still be used as a choice for cranioplasty.In the use of autologous skull,attention should be paid to the prevention and control of early infection and follow-up of bone resorption should be strengthened.In the use of titanium mesh,attention should be paid more to the prevention and control of hemorrhagic complications and late infection.3.Titanium mesh and autologous skull are the two most commonly used cranioplasty materials in main hospitals in Shandong province.The application of bone cement composite materials was gradually decreasing;PEEK application was relatively few while with rapid growing.In recent years,the number of hospitals preserving autologous bone gradually decreased,and the proportion of artificial skull increased year by year.4.In the current used autologous skull,the primary cause of cranioplasty failure was due to surgical site infection.Compared with autologous skull and artificial materials,no obvious advantages were shown in terms of total complications and cranioplasty failure.