内镜下颅缝条状切除术治疗矢状缝早闭疗效分析

Efficacy of endoscopic strip craniectomy for sagittal synostosis

目的 探讨神经内镜下颅缝条状切除术联合术后颅骨矫形头盔治疗矢状缝早闭患儿的临床疗效。方法 选择2019年6月至2022年6月上海市儿童医院收治的20例矢状缝早闭患儿,均行神经内镜下颅缝条状切除术,术后订制颅骨矫形头盔辅助治疗,手术前后根据头部CT检查测量颅骨横径、前后径、眉间至横径距离以计算头颅指数(CI)和最大宽度点(PMW)。结果 共20例患儿均顺利完成手术,手术成功率为100%,手术区域均未留置引流管,术后无一例出现骨瓣移位、脑脊液鼻漏、继发性感染等并发症,以及颅骨截骨导致的神经功能缺损、骨片游离导致的继发性损伤。术后6个月和末次随访时,19例患儿头型预后良好;1例2月龄女性患儿头型预后不良(术后6和12个月CI分别为72%和74%)。本组患儿手术前后CI(F=230.542,P=0.000)和PMW(F=112.166,P=0.000)差异具有统计学意义,其中,术后6个月和末次随访CI(t=-14.231,P=0.000;t=-21.041,P=0.000)和PMW(t=-8.068,P=0.000;t=-16.109,P=0.000)均高于术前,末次随访亦高于术后6个月(t=-6.810,P=0.000;t=-8.040,P=0.000)。结论 神经内镜下颅缝条状切除术联合术后颅骨矫形头盔治疗可以改善矢状缝早闭患儿头型预后,且安全有效。

Objective To explore the clinical effect of endoscopic strip craniectomy with orthotic skull helmet for sagittal synostosis.Methods A total of 20 children with sagittal synostosis admitted to Shanghai Children's Hospital from June 2019 to June 2022 were included.All of them underwent endoscopic strip craniectomy and customized orthotic skull helmet assisted treatment after the surgery.Cephalic index(CI)and point of maximum width(PMW)were calculated by measuring transverse diameter of skull,anterior and posterior diameter of skull,and distance between eyebrow and transverse diameter of skull.Results All 20 sagittal synostosis children successfully completed the surgery,the success rate of the surgery was 100%,and no indwelling drainage tube was placed in the surgical area.There were no postoperative complications such as bone flap displacement,cerebrospinal fluid leakage,secondary infection,nerve function defect caused by skull osteotomy and secondary injury caused by bone fragments ionization.At 6 months after sugery and last follow-up,19 children showed a favorable prognosis in terms of cranial shape,while one 2-month-old female child had an unfavorable head shape prognosis(CI was 72%at 6 months after sugery,and 74%at the last follow-up).There were statistically significant differences between CI(F=230.542,P=0.000)and PMW(F=112.166,P=0.000)before and after surgery.Among them,CI(t=-14.231,P=0.000;t=-21.041,P=0.000)and PMW(t=-8.068,P=0.000;t=-16.109,P=0.000)at 6 month after surgery and last follow-up were higher than those before surgery.CI(t=-6.810,P=0.000)and PMW(t=-8.040,P=0.000)at last follow-up were higher than those at 6 month after surgery.Conclusions Endoscopic strip craniectomy with orthotic skull helmet can improve the cranial shape of children with sagittal synostosis and is considered safe and effective.