π形截骨术联合矫形头盔治疗婴儿矢状缝早闭

Pi craniectomy combined with orthopedic helmet for treatment of infant sagittal synostosis

目的:探讨π形截骨术联合矫形头盔治疗婴儿矢状缝早闭的临床效果。方法:回顾性分析2020年5月至2021年3月首都医科大学附属北京儿童医院神经外科收治的矢状缝早闭患儿的临床资料。首先采用π形截骨进行治疗,自冠状缝后约1.0 cm处横行截取宽约1.5 cm骨条,两端至左右颞顶缝处,且横跨矢状窦上方;自闭合的矢状缝旁开1.5 cm处平行于矢状缝及人字缝截取弧形骨条至颞顶缝处,骨条平行于矢状缝处宽约2.0 cm,平行于人字缝处宽约1.0 cm左右,两侧对称性截骨,截取的骨条类似π形。术后1~2周开始佩戴矫形头盔,每天20~22 h,矫正6~10个月。术后定期随访,观察头颅形态,测量头颅横径和前后径,计算头颅指数(CI)及颅腔容积,CI为头颅横径与前后径的比值,CI<0.75为效果不满意,CI在0.75~0.90为效果满意。结果:共纳入单纯矢状缝早闭患儿4例,均为男性,5~11个月龄,术前患儿CI为0.69~0.73,颅腔容积576.7~853.2 ml。所有患儿手术过程安全,术中用时2.13~2.28 h,出血量30~100 ml。术后住院时间为7~10 d,患儿仅出现头顶部、枕部皮下肿胀(7~10 d后自行恢复)及发热表现,经对症处理后体温于术后5 d内恢复正常;均未出现神经系统异常表现,未发生脑膜炎、硬膜破损导致的脑脊液漏及硬膜外血肿等表现。随访6~7个月,所有患儿头颅外形均较术前有所改善,CI为0.76~0.80,头颅宽长比趋于正常,颅腔容积为757.3~1261.4 ml,较术前明显增大。结论:π形截骨术联合矫形头盔辅助治疗婴儿矢状缝早闭,手术时间短,术中出血少,术后并发症少,可以明显改善舟状头外观,使头颅宽长比趋于正常,并动态扩大颅腔容积。

Objective To investigate the clinical effect of pi craniectomy combined with orthopedic helmet on sagittal synostosis in infants.Methods Clinical data of patients with sagittal synostosis treated in the Department of Pediatric Neurosurgery,Beijing Children’s Hospital Affiliated to Capital Medical University from May 2020 to March 2021 were retrospectively analyzed.First treatment was pi craniectomy.A bone strip about 1.5 cm wide was transversely cut from the place about 1.0 cm behind the coronal suture,and its left and right sides went respectively up to the left and right temporoparietal suture and across the sagittal sinus.From the place about 1.5 cm beside the closed sagittal suture,an arc-shaped bone strip was cut paralleling to the sagittal and lambdoidal sutures to the temporoparietal suture.The bone strip was about 2.0 cm wide parallel to the sagittal suture and 1.0 cm wide parallel to the lambdoidal suture.Subsequently,the left and right sides were symmetrically cut with the bone strips shaped asπ.Then,1-2 weeks after operation,the orthopedic helmet was used 20-22 hours a day for 6-10 months.Regular follow-up after surgery,cranial morphology was observed,transverse diameter and anteroposterior diameter of skull were measured,cranial index(CI)and cranial volume were calculated.CI was the ratio of transverse diameter to anteroposterior diameter of skull.CI<0.75 was unsatisfactory,and CI 0.75-0.90 was satisfactory.Results A total of 4 patients with sagittal synostosis were included in this study,all males,5 to 11 months old.Preoperative CI was 0.69-0.73,cranial volume 576.7-853.2 ml.All the patients were operated safely.The duration of operation was 2.13-2.28 h,and the amount of blood loss was 30-100 ml.Meanwhile,postoperative hospital stay ranged from 7 to 10 days.After operation,the patients showed subcutaneous swelling of the parietal and occipital areas(self-healing after 7-10 days)and fever.The temperature returned to normal within 5 days.None of the patients presented any neurological abnormalities,cerebrospinal fluid leakage and epidural hematoma caused by meningitis,and dural damage.The postoperative follow-up was 6 to 7 months.According to the results,it indicated that the cranial shape of all the infants was improved.Postoperative CI was 0.76-0.80.The cranial width-length ratio tended to be normal.Postoperative cranial volume was 757.3-1261.4 ml,and the cranial cavity volume increased significantly.Conclusion Pi craniectomy combined with orthopedic helmet assisted treatment of infant with sagittal synostosis has many advantages.It has short operation time,less intraoperative bleeding and less postoperative complications.It can significantly improve the appearance of the scaphoid head,make the ratio of skull width to length normal,and dynamically expand the volume of the cranial cavity.