牵张成骨后皮罗序列征患儿的体质量变化

Body weight changes in children with Pierre Robin syndrome after distraction osteogenesis

背景:牵张成骨能有效改善皮罗序列征患儿的气道梗阻,术后患儿生长发育抑制能得到明显改善,尤其表现在患儿体质量的增长方面,然而目前没有数据来评价早期牵张成骨后皮罗序列征患儿体质量增长的变化情况。目的:记录皮罗序列征患儿不同阶段体质量百分位数变化情况,并与单纯腭裂及未行牵张成骨皮罗序列征患儿进行对比,评估早期牵张成骨对患儿生长发育的影响。方法:收集广州市妇女儿童医疗中心2015至2018年收治的56例严重皮罗序列征患儿的临床资料,其中41例进行下颌骨牵张成骨术(牵张成骨组),分别记录5个时间点(出生、初次就诊、下颌骨牵张成骨术前、拆除牵张器及腭裂手术)的体质量。将患儿的体质量转化为体质量百分位数,利用统计软件制作患儿生长速度曲线图;按下颌骨牵张成骨术实施年龄,将患儿分成3组(<1个月、1-3个月、4-7个月),同时收集21例单纯腭裂(单纯腭裂组)及15例未行牵张成骨皮罗序列征患儿(未手术组)5个时间点的体质量百分位数资料,进行组间对比。所有患儿监护人对治疗方案均知情同意,且得到医院伦理委员会批准。结果与结论:(1)牵张成骨组患儿平均体质量百分位数从出生的34.4±23.0下降至下颌骨牵张成骨术前的13.1±15.3(P <0.001);拆除牵张器时体质量百分位数上升至28.2±24.1,与下颌骨牵张成骨术前相比差异有显著性意义(P <0.05);随访时的体质量百分位数上升至42.4±14.1,与拆除牵张器时比较差异有显著性意义(P <0.001);(2)在(10.6±2.6)个月随访时,牵张成骨组患儿体质量百分位数显著大于未手术组皮罗序列征患儿(P <0.001),单纯腭裂组与牵张成骨组差异无显著性意义(P> 0.05);(3)在第1次就诊时,手术年龄1-3个月组及4-7个月组体质量百分位数较<1个月组下降明显(P<0.05);(4)提示牵张成骨有利于减少皮罗序列征对患儿体质量百分位数增长抑制的影响,越早期手术,越有利于患儿体质量的增长。

BACKGROUND: Distraction osteogenesis can effectively improve airway obstruction in children with Pierre Robin syndrome. The growth inhibition of postoperative children can be significantly improved, especially in the growth of children’s body weight. However, there is no data to evaluate early distraction can benefit in body weight growth in children with post-osteogenesis.OBJECTIVE: To record changes in body weight percentile at different stages of the Pierre Robin syndrome and compare with those with cleft palate and undistracted osteogenesis column to evaluate the effect of early distraction osteogenesis on growth and development of child patients.METHODS: The clinical data of 56 cases of severe Pierre Robin syndrome in Guangzhou Women and Children’s Medical Center from 2015 to2018 were collected, including 41 cases of mandibular distraction osteogenesis. The weight at 5 time points(birth, initial visit, before mandibular distraction osteogenesis, removal of distractor and cleft palate surgery) were recorded. The body weight of the child was converted into body weight percentile, and the growth rate curve of the child was made using statistical software. According to the age of the distraction osteogenesis, patients were divided into three groups(< 1 month;1-3 months;4-7 months). Simultaneously, body weight percentile of 21 cases of cleft palate(cleft palate group) and 15 cases of undistracted osteogenesis Pierre Robin syndrome(undistracted osteogenesis group) were collected and compared among groups. All the guardians of the children signed informed consent. This study was approved by the Hospital Ethics Committee.RESULTS AND CONCLUSION:(1) The mean body weight percentile decreased from 34.4 ± 23.0 at birth to 13.1 ± 15.3 before the mandibular distraction osteogenesis in the distraction osteogenesis group(P < 0.001). The body weight percentile increased to 28.2 ± 24.1 when the distractor was removed, showing significant difference as compared with that before mandibular distraction osteogenesis(P < 0.05).At follow-up, the body weight percentile increased to 42.4 ± 14.1 as compared with that after removal of the distractor(P < 0.001).(2) At 10.6 ±2.6 months follow-up, the body weight percentile was significantly greater in the distraction osteogenesis group than in the undistracted osteogenesis group(P < 0.001). There was no significant difference between the cleft palate group and the distraction osteogenesis group(P > 0.05).(3) At the first visit, the body weight percentile in the group(1-3 months) and(4-7 months) was significantly lower than in the group(< 1 month)(P < 0.05).(4) It is indicated that distraction osteogenesis is effective to reduce the growth inhibition of the child’s weight percentile in server Pierre Robin syndrome. The earlier the surgery, the better the growth of the child’s body weight is.