额部斜头畸形的整复手术

The plastic surgery for plagiocephaly

目的总结额部斜头畸形——单侧冠状缝早闭症的整复手术方法。方法应用浮动额骨瓣原理，采用额眶前移、额顶骨瓣、颞顶骨瓣替代畸形额骨并再造额眶3种术式修复斜头畸形，以可吸收板固定颅骨骨段。结果2008年1月至2010年12月，于临床应用9例，所有患者均获得满意疗效，未出现严重并发症。术后随访1～2年，颅骨眼眶形态得以重建，解除了早闭的颅骨缝对大脑发育的限制，避免受累颅骨缝再次早闭及颅面畸形复发。采用可吸收板固定，避免出现金属固定板陷入颅骨的远期并发症，亦不影响患儿颅脑的生长发育。结论额眶前移、额顶骨瓣、颞顶骨瓣替代额骨的术式可矫正斜头畸形，获得较为满意的颅眶形态，且这3种手术技术近期效果良好，对于颅面骨发育生长、大脑和视觉功能的远期影响，尚有待于进一步随访观察。

Objective To sum up three types of plastic procedures for frontal plagiocephaly （unilateral coronal synostosis）. Methods Based on the principle of floating forehead, the plagiocephaly was corrected and orbito-frontal reconstruction was performed by orbito-frontal advancement, or temporo- parietal osteotomy, or fronto-parietal osteotomy. The absorbable plates and microscrews composed of polylactide polymers, were used to immobilize calvarial segments. Results From January 2008 to December 2010, 9 cases of plagiocephaly were treated with satisfactory result and no severe complication. The patients were followed up for 1-2 years with no recurrence of suture fusion and deformity. The brain development was not restricted. The absorbable plates were applied to avoid the metal fixation moving into the cranial bone. Conclusions The three types of plastic procedures, orbito-frontal advancement, or temporo-parietal osteotomy, or fronto-parietal osteotomy, can correct the plagiocephaly with satisfactory orbito-frontal appearance. Long-term follow-up is needed to observe the long-term effect of the orbito-frontal reconstructive operation on mental and calvarial development as well as visual function.