颅阔点在非综合征型矢状缝早闭临床评价中的应用

The clinical application of the location of euryon in nonsyndromic sagittal synostosis

目的探讨颅阔点位置在非综合征性矢状缝早闭临床评价中的应用价值。方法回顾性分析2012年1月至2018年4月复旦大学附属儿科医院整形外科收治的17例非综合征型矢状缝早闭患儿的CT数据,其中男12例,女5例,术前年龄为2~72个月,平均18.3个月。并收集同时段在同一医院行头颅CT检查的17例颅脑外伤患儿的CT数据作为对照组,其中男10例,女7例,年龄4~72个月,平均19.3个月。将薄层CT图像传至GEAdvantage Workstation4.5后处理工作站进行容积显示、多平面重建,采用工作站自带直线测量工具测量对照组以及矢状缝早闭患儿术前和术后颅阔点前后向相对位置(简称颅阔点水平位置)、颅阔点垂直向相对位置(简称颅阔点垂直位置)。采用GraphpadPrism6.0对数据进行统计分析。2组间数据比较采用t检验,对术后半年到1年进行过CT随访的8例矢状缝早闭患儿术前和术后颅阔点位置比较采用配对t检验,P<0.05为差异有统计学意义。结果矢状缝早闭患儿术前颅阔点水平位置为46.50%±4.02%,对照组为50.39%±2.21%,2组数据比较差异有统计学意义(t=3.49,P=0.0014);矢状缝早闭患儿术前颅阔点垂直位置为35.78%±8.62%,对照组为52.6%±8.08%,2组数据比较差异有统计学意义(t=5.86,P<0.001)。获得CT随访的8例患儿术前颅阔点水平位置为44.02%±3.72%,术后为47.25%±4.23%,两者比较差异有统计学意义(t=2.420,P=0.0450);术前颅阔点垂直位置为35.18%±5.36%,术后为42.39%±9.06%,两者比较差异有统计学意义(t=2.554,P=0.0379)。结论颅阔点作为头颅指数的补充,可以便捷有效地反应矢状缝早闭患儿头颅两侧最突点的术后恢复情况。

Objective In clinical, cephalic index is the most common method to evaluate scaphocephaly. However, cephalic index alone is not sufficient to describe the nuances of skull shape. The authors hypothesize that the location of euryon could be a valuable and practical index as the supplement of cephalic index to better describe the skull. Methods This is a retrospective study. CT scans of 17 scaphocephaly patients and 17 normal controls were included. Eight of 17 scaphocephaly patients have 6 months postoperative CT scan. The preoperative location of euryon of scaphocephaly patients was compared to that of the controls and postoperative. The horizontal location of euryon was defined as the ratio of the distance, from the most prominent point of forehead to euryon, to anteroposterior cranial length. The vertical location of euryon was defined as the ratio of the vertical distance, from the nasion to euryon, to cranial height. Results Both the horizontal and vertical locations of euryon of preoperative scaphocephaly patients were significantly decreased compared to normals (46.50%±4.02% vs. 50.39%±2.21%, t=3.49, P=0.0014;35.78%±8.62% vs. 52.6%±8.08%, t=5.86, P<0.001). Both the postoperative horizontal vertical locations of euryon were significantly increased, when compared to preoperative (47.25%±4.23% vs. 44.02%±3.72%, t=2.42, P=0.045;42.39%±9.06% vs. 35.18%±5.36%, t=2.554, P=0.0379). Conclusions The location of euryon could be a practical and valuable index to describe the nuances of skull shape.