简易榫卯成形骨瓣固定治疗单侧冠状缝早闭

Treatment of unilateral coronal synostosis by fronto-orbital advancement with simple tenon forming fixation

目的总结简易榫卯成形骨瓣固定治疗单侧冠状缝早闭的经验效果。方法回顾性分析2014年9月至2015年12月间，采用额眶桥前移＋额骨瓣榫卯成形骨瓣固定术治疗6例单侧冠状缝早闭患儿，运用计算机三维重建软件（Mimics 10.01和Magics 19.0.1）分析患儿术前、术后颅骨形态改变，测量头颅指数（CI）、颅顶不对称差值（CVAI）、前颅顶不对称差值（ACVAI）、后颅顶不对称差值（PCVAI）等数据，并随访结果，总结治疗经验.结果6例患儿中，男1例，女5例；年龄5～17个月；左侧2例，右侧4例，合并颅内高压2例。术前6例CI值均大于85%，均值为95.4%±8.9%，CVAI、ACVAI和PCVAI分别为10.1%±7.4%、17.1%±7.1%和7.5%±6.1%，均有不同程度增大。2例合并颅内高压患儿颅骨变形严重：CI〉100%，CVAI〉18.7%，ACVAI〉20%且PCVAI〉14%。术后1个月复测6例患儿头颅形态CI（92.7%±8.1%）、CVAI（3.7%±4.0%）、ACVAI（6.6%±3.2%）和PCVAI（5.2%±3.5%）均较术前明显改善，且差异有统计学意义（P〈0.05）。其中CVAI和ACVAI改善尤为突出。本组患儿术后除术侧额眶部肿胀，3例贫血予以输血治疗外，未出现脑脊液漏、颅内外感染、头皮坏死等严重并发症。随访6～12个月，外观满意，无骨瓣移位及复发。结论应用简易榫卯成形骨瓣固定术治疗单侧冠状缝早闭，手术操作难度小，术后固定效果稳定，能明显改善颅面骨外观，扩大颅腔容积，近期效果良好，远期对大脑发育的影响及外观改善有待进一步观察。

ObjectiveTo summarize the experiences of treating unilateral coronal synostosis （UCS） by fronto-orbital advancement with simple tenon forming fixation.MethodsWe retrospectively analyzed UCS children undergoing fronto-orbital advancement with simple tenon forming fixation from September 2014 to December 2015.The skull morphological changes of cephalic index （CI）, cranial vault asymmetry index （CVAI）, anterior cranial vault asymmetry index （ACVAI） and posterior cranial vault asymmetry index （PCVAI） before and after surgery were analyzed by 3-dimensionl remodeling software （Mimics 10.01 ＆ Magics 19.0.1）. The follow-up results were collected to summarize the experiences of treatment.ResultsA total of 6 cases with unilateral coronal synostosis were recruited.There were 1 boy and 5 girls with an age range of 5 to 17 months.The involved sides were left （n=2） and right （n=4）. Two had concurrent high intracranial pressure （ICP）. The preoperative CI values were greater than 85% with an average of 95.4%±8.9%.And CVAI, ACVAI and PCVAI were increased by an average of 10.1%±7.4%, 17.1%±7.1% and 7.5%±6.1% respectively.Skull deformation was severe in 2 ICP children： CI〉100%, CVAI〉18.7%, ACVAI〉20% and PCVAI〉14%.The postoperative values of CI, CVAI, ACVAI and PCVAI were 92.7%±8.1%, 3.7%±4.0%, 6.6%±3.2% and 5.2%±3.5% respectively.As compared with preoperative values, improvements had significant differences （P〈0.05）. Except for 3 cases of blood transfusion due to anemia, there was no onset of such serious complications as cerebrospinal fluid leakage, intracranial infection or scalp necrosis.During a follow-up period of 6-12 months, appearance was satisfactory without recurrence or osseous flap transposition.ConclusionsUnilateral coronal synostosis may be successfully managed by fronto-orbital advancement with simple tenon forming fixation.With a lower operative difficulty and better fixation stability, it has excellent short-term clinical outcomes.However, the long-term effects on brain development and craniofacial appearance require further investigations.