Cranioplastia com implante prototipado – uma revisão sitemática e metanálise proporcional
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Data
2018-07-30
Autores
Gonçalves, Marcelo Pacheco
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Universidade Estadual Paulista (Unesp)
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RESUMO GONÇALVES M. P. Cranioplastia Com Implante Prototipado – Uma Revisão Sistemática e Metanálise Proporcional. 2018. 67. Dissertação (Mestrado) - Faculdade de Medicina de Botucatu, Universidade Estadual Paulista “Júlio de Mesquita Filho”, Botucatu, 2018. Introdução: com o avanço tecnológico e popularização de softwares e impressoras 3D, cranioplastias com implantes aloplásticos prototipados tornaram-se mais uma ferramenta para correção de falhas ósseas secundárias a craniectomias. Assim, seu uso cada vez mais comum, abre uma área com necessidade de maiores estudos e discussões. Objetivos: revisar os artigos da literatura referentes a cranioplastia com implantes prototipados 3D em pacientes submetidos a craniectomia descompressiva secundários à trauma, acidente vascular encefálico hemorrágico e pós ressecção tumoral Métodos: Realizou-se uma revisão literária buscando artigos com descritores controlados nas bases de dados Medical Literature Analisys And Retrievel Sistem Online (MedLine), Biblioteca Virtual em Saúde (BVS), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Scientifc Eletronic Library Online (SciELO). Realizaram-se todas as combinações possíveis entre os descritores em cada base de dados, utilizando-se o conector booleando “AND”. Assim, foram encontrados 185 artigos, sendo 114 na base de dados da Medline, 71 na BVS e nenhum na LILACS e SciELO. Dentre um levantamento de dados de estudos de séries de casos foi montada a TABELA BASE, na qual o teste utilizado para realizar as comparações estatísticas foi o Teste de Normalidade. Resultados: Quatorze artigos selecionados foram publicados até março de 2017. Todos são séries de caso. Na analise estatística, infecção Np (amostra de cranioplastia prototipada) versus infecção Na (amostra de cranioplastia com autoenxerto) versus infecção Nt (amostra de cranioplastia com titânio) o valor é p = 0,7044; a incidência da exposição do material da cranioplastia Np versus exposição Na versus exposição Nt o valor é p < 0,0001 na análise global das três amostras; a necessidade de reabordagem cirúrgica na análise global, reabordagem Np versus reabordagem Na versus reabordagem Nt, p < 0,0001; a necessidade de retirada de material da cranioplastia Np versus retirada de Na versus retirada de Nt, p < 0,0001; deslocamento pós cirúrgico do material da cranioplastia Np versus Na, p = 1,0; Na reabsorção do material da cranioplastia Np versus reabsorção Na, p < 0,0001; a deiscência de ferida operatória Np versus deiscência de Nt, p < 0,001; assimetria Np versus assimetria Na o valor é p = 0,0012; a incidência total de complicações de cada técnica cirúrgica a comparação global foi de p < 0,0001. Discussão: Realizou-se a análise dos artigos selecionados, avaliando técnicas de prototipagem utilizadas por cada serviço, assim como seus resultados estéticos finais, incidências de infecção, necessidade de reabordagem cirúrgica. Conclusão: Não há diferença estatística entre a incidência total de complicações entre as modalidades de craniplastias com enxerto ósseo ou implante prototipado. Mas, devido a pequena amostra das séries, estudos maiores são necessários.
Introduction: Cranioplasties with prototyped alloplastic implants have become another tool for bone defects corrections due to craniectomies on account of technological advancement and popularization of software and 3D printers. Because of its increasing common use, there is a need of further studies and discussions. Objectives: To review literature articles on cranioplasty with 3D prototyped implants in patients submitted to decompressive craniectomy secondary to trauma, hemorrhagic encephalic stroke and post tumor resection. Methods: A literature review was carried out to search for articles with descriptors controlled in the Medical Literature Analyzes and Retrieve Sistem Online (MedLine), Virtual Health Library (VHL), Latin American and Caribbean Literature in Health Sciences (LILACS) and Scientifc Eletronic Library Online (SciELO). All possible combinations between the descriptors in each database were made using the "AND" boolean connector. Thus, 185 articles were found, 114 in the Medline database, 71 in the VHL, and none in LILACS and SciELO. From a data collection of case series studies, we assembled the BASE TABLE, in which the test used to perform the statistical comparisons was the Normality Test. Results: Fourteen selected articles were published until March 2017. All of them were case series. In the statistical analysis, infection Np versus infection Na versus infection Nt the value is p = 0.7044; the incidence of exposure of the Np cranioplasty material versus Na exposure versus Nt exposure the value is p <0.0001 in the overall analysis of the three samples; the need for surgical reassessment in the overall analysis, re-Np re-relaying versus N re-relaying Nt, p <0.0001; the need for removal of material from Np cranioplasty versus Na withdrawal versus Nt withdrawal, p <0.0001; postsurgical displacement of the Np versus Na cranioplasty material, p = 1.0; On reabsorption of Np cranioplasty material versus Na reabsorption, p <0.0001; Np operative wound dehiscence versus Nt dehiscence, p <0.001; asymmetry Np versus asymmetry Na the value is p = 0.0012; the total incidence of complications from each surgical technique was a global comparison of p <0.0001. Discussion: The articles were analyzed and we have assessed prototyping techniques used by each service, as well as their final aesthetic results, incidence of infection, and need for surgical reassessment. Conclusion: There is no statistical difference between the total incidence of complications between the modalities of craniplasties with bone graft or prototyped implant. But due to the small sample of the series, larger studies are needed.
Introduction: Cranioplasties with prototyped alloplastic implants have become another tool for bone defects corrections due to craniectomies on account of technological advancement and popularization of software and 3D printers. Because of its increasing common use, there is a need of further studies and discussions. Objectives: To review literature articles on cranioplasty with 3D prototyped implants in patients submitted to decompressive craniectomy secondary to trauma, hemorrhagic encephalic stroke and post tumor resection. Methods: A literature review was carried out to search for articles with descriptors controlled in the Medical Literature Analyzes and Retrieve Sistem Online (MedLine), Virtual Health Library (VHL), Latin American and Caribbean Literature in Health Sciences (LILACS) and Scientifc Eletronic Library Online (SciELO). All possible combinations between the descriptors in each database were made using the "AND" boolean connector. Thus, 185 articles were found, 114 in the Medline database, 71 in the VHL, and none in LILACS and SciELO. From a data collection of case series studies, we assembled the BASE TABLE, in which the test used to perform the statistical comparisons was the Normality Test. Results: Fourteen selected articles were published until March 2017. All of them were case series. In the statistical analysis, infection Np versus infection Na versus infection Nt the value is p = 0.7044; the incidence of exposure of the Np cranioplasty material versus Na exposure versus Nt exposure the value is p <0.0001 in the overall analysis of the three samples; the need for surgical reassessment in the overall analysis, re-Np re-relaying versus N re-relaying Nt, p <0.0001; the need for removal of material from Np cranioplasty versus Na withdrawal versus Nt withdrawal, p <0.0001; postsurgical displacement of the Np versus Na cranioplasty material, p = 1.0; On reabsorption of Np cranioplasty material versus Na reabsorption, p <0.0001; Np operative wound dehiscence versus Nt dehiscence, p <0.001; asymmetry Np versus asymmetry Na the value is p = 0.0012; the total incidence of complications from each surgical technique was a global comparison of p <0.0001. Discussion: The articles were analyzed and we have assessed prototyping techniques used by each service, as well as their final aesthetic results, incidence of infection, and need for surgical reassessment. Conclusion: There is no statistical difference between the total incidence of complications between the modalities of craniplasties with bone graft or prototyped implant. But due to the small sample of the series, larger studies are needed.
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Palavras-chave
cranioplastia, metilmetacrilato, impressão tridimensional, impressão 3D, impressora 3D, prototipagem, implante prototipado, cranioplasty