大范围颅骨切开并多块硬脑膜附着式颅骨瓣治疗婴幼儿矢状缝早闭63例  

Extensive cranioplasty for sagittal synostosis in young children by preserving multiple cranial bone flaps adhered to the dura mater： experience with 63 cases

作　　者：鲍南[1] 褚珺[2] 王雪[2] 杨波[1] 宋云海 蔡金晶[2] 

机构地区：[1]上海交通大学医学院附属上海儿童医学中心神经外科,200127 [2]上海交通大学医学院附属上海儿童医学中心整形外科,200127

出　　处：《中华整形外科杂志》2016年第1期9-13,共5页Chinese Journal of Plastic Surgery

摘　　要：目的探讨应用额、枕大骨瓣和大范围颅骨切开松解，多块硬脑膜附着式浮动颅骨瓣治疗婴幼儿矢状缝早闭的效果。方法2008年4月到2013年6月，对63例矢状缝早闭患儿，用气钻将双侧额骨瓣取下，枕骨瓣和两侧颞骨瓣切割开后，不从硬脑膜上分离下来，也不固定，使之成为浮动骨瓣，将颅底骨切割成栅栏状，仅在颅顶骨中央留下一宽约2cm的长条形骨桥。随后，将额骨瓣和枕骨瓣向中线推挤，并与顶骨桥连接固定，以缩短颅腔的前、后径，并使颅脑向两侧膨胀，矫正舟状头畸形。结果术后随访1～5年，平均43个月，患儿颅骨生长良好，颅腔前、后径平均缩短14．6mm，横径平均增大12．3mm，前倾的前额部被纠正，舟状头畸形明显改善，无死亡、颅骨坏死等并发症。术后1年CT可见顶骨两侧人工矢状沟逐渐融合，术后2～3年颅骨几乎完全正常愈合，5年内未见头颅畸形复发。61例智力正常，2例术前智力低于正常者，未得到改善。结论大范围颅骨切开并多块硬脑膜附着式浮动颅骨瓣可以较好地治疗婴幼儿矢状缝早闭，手术创伤小，出血少，减轻颅脑压迫效果好，有利于术中颅脑横向膨胀，以及日后大脑的正常发育。Objective This study aimed to evaluate the effort of applying frontal and occipital bones in extensive cranioplasty and preserving multiple cranial bone flaps adhered to the dura mater in the treatment of sagittal synostosis. Methods From April 2008 to June 2013 ,sixty-three children with sagittal synostosis, aged 5 months to 3 years, were included in the study. The frontal bone flap was removed using an air drill. The occipital and bilateral temporal bone flaps were cut open but not detached from the dura mater or fixed to produce floating bone flaps. The skull bone was cut into palisade-like structures. Brain compression from both sides and the base of the skull was released and the brain expanded bilaterally through the enlarged space. Only a long strip-shaped bone bridge remained in the central parietal bone. Subsequently, the frontal bone flaps and occipital bone flap were pushed towards the midline and fixed with the parietal bone bridge to shorten the anteroposterior diameter of the cranial cavity and allow the brain to expand bilaterally to correct scaphocephaly. The CT images showed that both sides of the parietal bone of artificial sagittal groove gradually merged postoperative 1 year, and skull almost completely normal healing after operation 2 or 3 years, without deformity recurrence within 5 years. Among them all, 61 children＇s intelligence is normal and 2 children＇ s lagged behind normal level, no further improvement. Results Patients were followed up 1 - 5 years （ an average of 43 months ）. Skull growth was excellent in allpatients, the anteroposterior diameter was shortened by 14. 6 mm averagely, the transverse diameter was increased by 12.3 mm averagely, the prominent forehead was corrected, and scaphocephaly improved significantly. There were no complications such as death and skull necrosis. Conclusions The application of frontal and occipital bones in extensive cranioplasty and preserving multiple cranial bone flaps adhered to the dura mater can be used in the treatment of sagittal syn

关 键 词：矢状缝早闭 颅骨成形术 儿童 

分 类 号：R726.5[医药卫生—儿科]