π型截骨术后辅助头盔治疗与颅骨重建术治疗婴幼儿非综合征型矢状缝早闭的疗效比较

A comparison of π craniectomy plus orthopedic helmet versus cranial vault remodeling for non-syndromic premature sagittal suture in infants

目的对比π型截骨术后辅助头盔治疗与颅骨重建术治疗婴幼儿非综合征型矢状缝早闭的围手术期风险因素及术后疗效,探讨两种治疗方法的优劣,为婴幼儿非综合征型矢状缝早闭个体化治疗方案的选择提供参考。方法回顾性分析2018年5月至2023年5月首都医科大学附属北京儿童医院神经外科收治的非综合征型矢状缝早闭婴幼儿临床资料,根据治疗方法分为π型截骨术后辅助头盔治疗组和颅骨重建术治疗组,对两组患儿围手术期数据以及术前、术后随访期间头颅指数和颅腔容积进行统计学分析。结果π型截骨术后辅助头盔治疗组11例,男8例、女3例;颅骨重建术组6例,男4例、女2例。π型截骨术后辅助头盔治疗组与颅骨重建术治疗组患儿术前、术后随访期间头颅指数以及术前颅腔容积分别为:术前头颅指数(0.72±0.06)比(0.67±0.04),术后随访期间头颅指数(0.77±0.06)比(0.73±0.01),术前颅腔容积(753.54±94.25)mL比(812.02±79.89)mL,以上差异均无统计学意义(P>0.05)。而年龄[(8.23±2.10)个月比(14.57±5.54)个月]、手术时长[(2.24±0.22)h比(5.00±0.52)h]、术中出血量[70.0(57.5,122.5)mL比120.0(100.0,127.5)mL]、住院费用[31355.0(27595.0,37554.0)元比116414.5(98185.3,124383.5)元]以及术后随访颅腔容积[(823.72±93.94)mL比(956.54±149.31)mL]比较,差异均有统计学意义(P<0.05)。结论π型截骨术后辅助头盔治疗和颅骨重建术治疗婴幼儿非综合征型矢状缝早闭,均能改善患儿头颅指数和颅腔容积;π型截骨术后辅助头盔治疗手术时间短、术中出血少、治疗费用低,而颅骨重建术对于患儿术后颅腔容积的扩大更具优势。

Objective To compare the perioperative risk factors and postoperative efficacy ofπcraniectomy plus orthopedic helmet versus cranial vault remodeling for non-syndromic premature sagittal suture and examine the advantages and disadvantages of two treatments to provide references for formulating individualized treatment plans for infantile non-syndromic sagittal premature closure.Methods From May 2018 to May 2023,retrospective review was conducted for hospitalized infants with non-syndromic sagittal premature closure.Perioperative data,perioperative cephalic index and intracranial volume were statistically examined.T test was utilized for normal distribution data and Mann-Whitney test for non-normal distribution data.P<0.05 implied statistically significant inter-group difference.Results There were 11 children(8 boys,3 girls)inπcraniectomy plus orthopedic helmet group.Cranial vault remodeling group included 6 children(4 boys,2 girls).No significant inter-group difference existed in pericephalic index or preoperative intracranial volume(P>0.05).Preoperative cephalic index[(0.72±0.06)vs.(0.67±0.04)],postoperative cephalic index[(0.77±0.06)vs.(0.73±0.01)]and preoperative intracranial volume[(753.54±94.25)vs.(812.02±79.89)ml].However,differences of statistical significance existed in age[(8.23±2.10)vs.(14.57±5.54)month],operation duration[(2.24±0.22)vs.(5.00±0.52)h],intraoperative volume of blood loss[70.0(57.5,122.5)vs.120.0(100.0,127.5)mL],hospitalization expense[31355.0(27595.0,37554.0)vs.116414.5(98185.3,124383.5)yuan]and postoperative follow-up intracranial volume[(823.72±93.94)vs.(956.54±149.31)mL](P<0.05).Conclusions Bothπcraniectomy plus orthopedic helmet and cranial vault remodeling may improve intracranial volume and cephalic index of infants with non-syndromic premature sagittal suture.However,πcraniectomy plus orthopedic helmet offers the advantages of shorter operative duration,less intraoperative volume of hemorrhage and lower hospitalization expense.Cranial vault remodeling is reserved for postoperative expansion of intracranial volume.