3D打印聚醚醚酮材料在颅脑损伤后颅骨成形术中的应用疗效分析

目的对比分析聚醚醚酮（PEEK）和钛网在颅脑损伤（TBI）后颅骨成形术中的临床疗效，并探讨PEEK材料的潜在优势。 方法选取解放军联勤保障部队第九〇一医院神经外科自2017年1月至2021年1月行颅骨成形术的48例TBI患者为研究对象，按照使用材料的不同将患者分为PEEK组（20例）和钛网组（28例）。比较2组患者手术出血、平均手术时间、住院时间、术后并发症、塑形效果及总治疗费用方面的差异。术后随访12个月，采用Karnofsky功能状态（KPS）评分评估患者的远期效果。 结果所有患者均于术后12~14 d拆除缝线，且切口为甲级愈合。2组患者手术出血、手术时间及住院时间比较，差异无统计学意义（P>0.05）。PEEK组术后总的并发症发生率（65.00%）与钛网组（60.71%）比较，差异无统计学意义（P>0.05）；2组术后颅内迟发性出血、术区硬膜下积液、术区颅内感染、癫痫及迟发性脑积水的发生率比较，差异无统计学意义（P>0.05）；钛网组患者的皮下积液发生率及治疗费用均低于PEEK组，差异具有统计学意义（P<0.05）。2组患者术后的平均满意度均较高，但PEEK组优于钛网组，差异具有统计学意义（P<0.05）。术后随访12个月，2组患者均未出现迟发性切口感染及材料外露，KPS评分比较差异无统计学意义（P>0.05）。 结论应用3D打印PEEK材料对TBI患者行颅骨成形术，总体并发症发生率与钛网材料相比无明显差异，但3D打印PEEK材料与颅骨契合更加完美，适合儿童、青少年及女性患者在经济情况好的条件下使用。

Application of 3D printed PEEK material in cranioplasty after traumatic brain injury

ObjectiveTo explore the potential advantages of polyetheretherketone (PEEK) material by comparing and analyzing the clinical efficacy of PEEK and titanium mesh in cranioplasty after traumatic brain injury (TBI). MethodsForty-eight patients who underwent cranioplasty after TBI in Neurosurgery Department of The 901^st Hospital of the Joint Logistics Support Force of PLA from January 2017 to January 2021 were analyzed retrospectively, including 20 patients who underwent cranioplasty with PEEK material (PEEK group) and 28 patients who underwent cranioplasty with titanium mesh (titanium mesh group). The intraoperative bleeding, operation time, hospital stay, postoperative complications, plastic effect and treatment cost were compared between the two groups. The patients were followed up for 12 months, and the long-term effect was observed by comparing Karnofsky functional state (KPS) score. ResultsThe sutures were removed in all patients 12-14 d after operation, the incision healed in grade A, and there were no infections and deaths. There was no significant difference in operation time, intraoperative bleeding and hospital stay between the two groups (P>0.05). The incidence of postoperative complications in PEEK group (65.00%) was similar to that in titanium mesh group (60.71%) (P>0.05), and there was no significant difference in postoperative complications such as intracranial hemorrhage, intracranial infection, subdural effusion, epilepsy and hydrocephalus between the two groups (P>0.05), but the incidence of subcutaneous effusion and total medical expenses in peek group were higher than those in titanium mesh group (P<0.05). The satisfaction of the two groups was higher, but the peek group was better than the titanium mesh group (P<0.05). After 12 months of follow-up, there was no delayed incision infection and material exposure. There was no significant difference in KPS score between the two groups 12 months after operation (P>0.05). ConclusionThere was no significant difference in the overall complication rate between 3D printed peek and titanium mesh in TBI patients undergoing cranioplasty. However, the 3D printed PEEK material fits more perfectly with the skull, which is suitable for children, adolescents and female patients under the condition of good economic conditions.