多块颅骨截骨加联合牵张成骨术治疗非综合征型舟状头畸形  

Multiple osteotomies with combined distraction osteogenesis for non-syndromic scaphocephaly

作　　者：高庆文[1] 季易[1] 崔杰[1] 陈建兵[1] 沈卫民[1] Gao Qingwen;Ji Yi;Cui Jie;Chen Jianbing;Shen Weimin(Department of Burn and Plastic Surgery, Children's Hospital of Nanjing Medical University, Nanjing 210008,China)

机构地区：[1]南京医科大学附属儿童医院烧伤整形外科,210008

出　　处：《中华整形外科杂志》2019年第2期105-111,共7页Chinese Journal of Plastic Surgery

摘　　要：目的探讨一种新的多块颅骨截骨加联合牵张成骨术治疗婴幼儿非综合征型舟状头畸形的方法和临床效果方法回顾性分析2017年1月至2018年10月南京医科大学附属儿童医院烧伤整形外科收治的8例非综合征型矢状缝早闭患儿的临床资料,男3例,女5例,年龄3~28个月,平均13个月,其中4例为典型的舟状头,2例为前舟状头,2例为后舟状头畸形根据舟状头畸形类型,设计不同的截骨方式和牵引方向采用超声骨刀将颅顶骨进行多块截骨,颅骨不从硬脑膜上分离,然后安置延长器,术后5d开始牵张,每日2次,0.4-0.6mm/d,延长10-15d,固定6个月后行二次手术拆除延长器。术前和术后对患儿行头颅三维CT扫描,测量头颅前后径和双颍部横径,计算头颅指数结果术后随访6~14个月,平均10个月一8例患儿术前颅前后径为(158.2±12.9)mm,术后为(145.5±14.2)mm,比术前缩短(12.6±3.4)mm;术前双颍部横径为(99.6±8.6)mm,术后为(113.9±7.5)mm,比术前延长(14.2±2.8)mm;术前和术后平均头颅指数分别为63.2和78.3,舟状头畸形得到明显改善未发生颅骨坏死、颅内感染等严重并发症结论采用不同方式的多块颅骨截骨加联合牵张成骨术可较好地治疗各种类型的婴幼儿舟状头畸形,获得较好的颅形和头颅指数。Objective To evaluate the clinical effect of multiple osteotomies combined with distraction osteogenesis in the treatment of non-syndromic scaphocephaly infants and young children. Methods Clinical records of 8 non-syndromic scaphocephaly patients, during January 2017 to October 2018, from the Department of Burn and Plastic Surgery, Children′s Hospital of Nanjing Medical University, were retrospectively analyzed. There were 3 males and 5 females, aged from 3 to 28 months, with an average of 13 months. Among them, 4 cases were typical scaphocephaly, 2 cases were anterior scaphocephaly and 2 cases were posterior scaphocephaly. According to the subtypes of scaphocephaly, different osteotomy methods and distraction directions were designed. The cranial vault was osteotomized by piezosurgery osteotomy in a multiple way. The dura did not separate from cranial flap. The internal distractors were installed subsequently. After a mean latency period of 5 days, the devices were activated at a rate of 0.4-0.6 mm/d. Distractor was extended twice a day. After 10-15 days activation period and 6 months consolidation, all the distractors were removed. Three-dimensional CT scans were performed before and after operation to measure the anteroposterior and bitemporal diameters, so as to calculate the cranial index. Results Follow-up ranged from 6 to 14 months (average, 10 months). The average anteroposterior length of 8 children was(158.2±12.9) mm before operation, and (145.5±14.2) mm after operation, which was shortened(12.6±3.4) mm. Bitemporal diameters was(99.6±8.6) mm preoperatively and(113.9±7.5) mm postoperatively, which was widened (14.2±2.8) mm. Preoperative and postoperative cranial index was 63.2 and 78.3, respectively. The scaphocephalic head shape was significantly improved in all patients. There was no serious complications such as skull necrosis or intracranial infection. Conclusions Different types of multiple osteotomy combined with distraction osteogenesis are useful to correct various scaphocephaly of infan

关 键 词：骨生成 牵张 矢状缝 颅缝早闭 舟状头畸形 联合牵张 

分 类 号：R726.5[医药卫生—儿科]