以健侧为镜像治疗单侧冠状缝早闭症疗效分析

Efficacy of unilateral coronal craniostenosis using healthy side as a mirror image

目的探讨婴幼儿单侧冠状缝早闭症的临床特点及手术治疗方法。方法回顾性分析湖南省儿童医院神经外科2019年3月至2023年3月收治的27例单侧冠状缝早闭症患儿临床资料。患儿年龄均大于3个月,头颅外观均呈不同程度前斜头畸形,均经头面部CT平扫加三维重建明确诊断,行3D打印设计骨瓣,根据颅骨畸形特点、畸形程度及就诊年龄制定手术方案。手术均以健侧为镜像行患侧眼眶重塑整形、以成形眶骨瓣为基线与额骨瓣契合成为"新额部"。观察患儿前斜头畸形改善情况以及颅腔容积变化。结果27例单侧冠状缝早闭症患儿术后平均随访2.4年(3个月至4年),双侧前额与双侧眼眶均位于同一冠状面,前斜头畸形与患侧额叶发育均较术前明显改善,无一例再次手术病例。结论对于大于3月龄的单侧冠状缝早闭患儿,采取以健侧为镜像重塑患侧眼眶,以成形眶骨瓣为基线重塑额骨瓣形成"新额头"的颅骨重塑整形手术,可获得满意疗效。

Objective To explore the clinical features and surgical approaches of unilateral coronal craniostenosis in infants.Methods From March 2019 to March 2023,the relevant clinical data were retrospectively reviewed for 27 infants aged over 3 months with unilateral coronary craniostenosis at Hunan Children's Hospital.There were varying degrees of anterior plagiocephaly in skull appearance.A definite diagnosis was made by plain cranial/facial computed tomography(CT)plus three-dimensional reconstruction.Bone flap was designed by three-dimensional printing.Surgical protocols were formulated by the characteristics,degree and age of cranial deformity.Healthy side was utilized as a mirror image for orbital remodeling at affected side.And formed orbital bone flap was employed as a baseline for fitting frontal bone flap into a"new frontal part".Anterior oblique deformity improved with the changes of cranial volume.Results The follow-up period was 28.8(3-48)month.Bilateral forehead and bilateral orbit were located in the same coronal plane.Development of anterior plagiocephaly and frontal lobe at affected side improved markedly as compared with pre-operation.None of them was re-operated.Conclusions In infants aged over 3 months with unilateral coronal craniostenosis,skull remodeling is efficacious using affected orbit with healthy side as a mirror image and frontal bone flap with orbital bone flap as a baseline into a"new forehead".