双顶部扩大颅缝再造术治疗儿童矢状缝早闭的疗效观察

Observation of therapeutic effect of biparietal cranial suture expansion and cranioplasty in the treatment of pediatric sagittal synostosis

目的观察双顶部扩大颅缝再造术治疗儿童矢状缝早闭的疗效。方法回顾性分析2016年12月至2021年8月昆明医科大学附属昆明市儿童医院神经外科采用双顶部扩大颅缝再造术治疗的83例矢状缝早闭患儿的临床资料。手术前、后行头颅CT三维重建检查,据此计算手术前、后的头颅指数(CI),以及术后颅顶不对称指数(CVAI;术后3个月CVAI<3.5为颅顶穹窿区重建形态对称),结合手术前后的头面部外观评价治疗效果。结果83例患儿均顺利完成手术。其中5例(6.0%)术中发生硬脑膜损伤,修补术后均未发生脑脊液渗漏;62例(74.7%)术中给予输血,输血量为(0.5±0.2)U;59例(71.1%)手术区域放置引流管。无一例患儿发生因颅骨截骨导致的神经功能损伤及骨片游离等导致的继发性损伤。83例患儿术后的随访时间为(13.0±1.4)个月(6~28个月)。术后结合影像学及头面部外观评估显示颅骨形态改善率为100%。术后第3天及3个月CI的中位数(范围)分别为0.73(0.68~0.85)及0.84(0.70~0.92),与术前的0.67(0.59~0.81)比较,差异有统计学意义(P<0.01)。术后3个月测定CVAI为0.20±0.04。2例(2.4%)患儿在术后2个月内截骨区被再生颅骨覆盖愈合而再次手术治疗。至末次随访所有患儿均未发生显著的颅骨愈合不良。结论双顶部扩大颅缝再造术治疗儿童矢状缝早闭,手术并发症发生率低;短时间内即可纠正头颅形态,需要再次手术的比率较低。

Objective To evaluate the therapeutic effect of biparietal cranial suture expansion and cranioplasty(BCSEC)in the treatment of pediatric sagittal synostosis.Methods The clinical data of 83 children with sagittal craniosynostosis who were treated with BCSEC in the Department of Neurosurgery of Kunming Children′s Hospital,Kunming Medical University from December 2016 to August 2021 were retrospectively analyzed.Three-dimensional CT examination of the head was performed before and after the operation,and the cephalic index(CI)before and after the operation,as well as the postoperative cranial vault asymmetry index(CVAI;CVAI<3.5 at the third month after surgery was considered symmetrical for the reconstruction of the cranial vault)were calculated based on this.The treatment effect was evaluated based on the appearance of the head and face before and after surgery.Results All 83 patients successfully underwent the operation.Among them,5 cases(6.0%)had intraoperative dural injury,and no cerebrospinal fluid leakage occurred after repair;62 cases(74.7%)received blood transfusion during the operation,and the blood transfusion volume was 0.5±0.2 U;59 cases(71.1%)underwent placement of a drainage tube in the surgical area.None of the children suffered from neurological damage caused by cranial osteotomy and secondary damage caused by free bone fragments.The postoperative follow-up time of 83 children was 13.0±1.4 months(6-28 months).Postoperative imaging and craniofacial appearance evaluation showed that the improvement rate of skull morphology was 100%.The CIs M(range)on the 3rd day and 3 months after operation were 0.73(0.68-0.85)and 0.84(0.70-0.92)respectively,which were significantly different compared with that before operation[0.67(0.59-0.81)](P<0.01).The CVAI at 3 months after operation was 0.20±0.04.Two cases(2.4%)underwent reoperation after the osteotomy area was covered by regenerated skull and healed within 2 months after operation.No significant cranial malunion occurred in the children up to the last follow-up.Conclusions BCSEC for the treatment of premature sagittal suture closure in children has a low incidence of surgical complications.The skull shape can be corrected in a short time,and the rate of reoperation is low.