额眶前移手术对额缝早闭患儿额叶容量及社会情绪改善的效果评价  

Improvements of frontal lobe volume and social emotions on metopic synostosis with frontal-orbital advancement

作　　者：李森 詹琪佳 肖波[2] 蒋文彬 魏民 陈欣 Li Sen;Zhan Qijia;Xiao Bo;Jiang Wenbin;Wei Min;Chen Xin(Department of Pediatric Neurosurgery,Shanghai Children's Hospital,Shanghai 200062,China;Department of Pediatric Neurosurgery,Shanghai Children's Medical Center,Shanghai 200333,China;Ward 6A,Shanghai Children's Hospital,Shanghai 200062,China)

机构地区：[1]上海市儿童医院,上海交通大学医学院附属儿童医院神经外科,上海200062 [2]上海交通大学医学院上海儿童医学中心神经外科,上海200333 [3]上海市儿童医院,上海交通大学医学院附属儿童医院6A病区,上海200062

出　　处：《临床小儿外科杂志》2024年第2期119-124,共6页Journal of Clinical Pediatric Surgery

基　　金：上海市科学技术委员会“科技创新行动计划”项目(20Y11905800)

摘　　要：目的探讨额眶前移手术改善额缝早闭患儿额叶容量和社会情绪的效果。方法回顾性分析自2017年1月至2021年10月在上海市儿童医院诊断并接受额眶前移手术治疗的15例额缝早闭患儿临床资料。分别于术前、术后1年及末次随访[术后(52±19)个月]时,采用头颅MRI检查及Slicer 5.4.0进行前额体积、脑体积和额角的计算,同期采用社会情绪调查量表对患儿社会情绪进行评估。结果15例均行额眶前移手术。术前额叶体积为106.58(103.38,112.35)cm^(3),脑体积为528.65(496.57,563.36)cm^(3),额角为91.3(89.6,93.3)°,额叶/脑比例为20(20,20)%;术后1年额叶体积为149.64(145.64,168.85)cm^(3),脑体积为623.71(587.76,651.87)cm^(3),额角为109.5(106.4,114.6)°,额叶/脑比例为24(20,30)%;末次随访时,额叶体积为217.18(208.44,238.42)cm^(3),脑体积为870.62(786.21,961.88)cm^(3),额角为116.4(113.4,120.7)°,额叶/脑比例25(20,30)%;上述指标于术后1年及末次随访显示均较术前明显改善(P<0.05)。术后1年额叶增长比例32(30,30)%,显著高于脑增长比例15(10,20)%,差异有统计学意义(P<0.05);末次随访时额叶增长比例51(50,50)%,脑增长比例39(30,40)%,差异有统计学意义(P<0.05)。患儿术前社会情绪得分为85(85,95)分,显著高于正常界值(50分);术后1年随访时,社会情绪显著下降至50(50,55)分,基本接近正常界值;末次随访时,社会情绪得分为35(30,40)分,15例患儿均低于界值,达到正常水平,较术前显著改善(P<0.05)。结论额眶前移术可显著增加额缝早闭患儿额叶容量,改善前额畸形,同时有效改善不良社会情绪。Objective To explore the therapeutic efficacy of frontal orbital advancement on improving social-emotional abnormalities and frontal lobe volume in children with metopic synostosis(MS).Methods From January 2017 to October 2021,retrospective review was performed for the relevant clinical data of 15 infants of premature closure of frontal suture managed with frontal orbital advancement.At the timepoints of pre-operation,1-year post-operation and during a final postoperative follow-up period of(52±19)month,Social-Emotional Assessment(ASQ:SE)was utilized for assessing social-emotional well-being.And cranial magnetic resonance imaging(MRI)along with 3D Slicer 5.4.0 software was employed for calculating frontal lobe volume,brain volume and frontal angle.Results Frontal orbital advancement was performed.Preoperative measurements of frontal lobe volume were 106.58(103.38,112.35)cm^(3),brain volume 528.65(496.57,563.36)cm^(3),frontal angle 91.3(89.6,93.3)°and frontal lobe/brain volume 20(20,20)%.At 1-year post-operation,frontal lobe volume was 149.64(145.64,168.85)cm^(3),brain volume 623.71(587.77,651.87)cm^(3),frontal angle 109.5(106.4,114.6)°and frontal lobe/brain volume 24(20,30)%.At the final follow-up,frontal lobe volume was 217.18(208.44,238.42)cm^(3),brain volume 870.62(786.21,961.88)cm^(3),frontal angle 116.4(113.4,120.7)°and frontal lobe/brain volume 25(20,30)%with statistical significance(P<0.05).At 1-year post-operation,proportion of frontal lobe growth was significant higher than brain growth[32(30,30)%vs.15(10,20)%,P<0.05].At the final follow-up,proportion of frontal lobe growth was significant higher than brain growth[51(50,50)%vs.39(30,40)%,P<0.05].Preoperative social-emotional scores of 85(85,95)were significantly higher than normal threshold.However,at 1-year post-operation,social-emotional scores 50(50,55)dropped markedly.At the final follow-up,all social-emotional scores 35(30,40)declined below a threshold and normalized.Conclusions For MS children,frontal orbital advancement may significantly boost

关 键 词：颅缝早闭 额缝早闭 外科手术 额眶前移 治疗结果 社会情绪评估 儿童 

分 类 号：R726.5[医药卫生—儿科]