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

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 ofepilepsy, 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.