早期应用神经内镜治疗婴儿非综合征型颅缝早闭的临床疗效分析  

Clinical efficacy analysis of early endoscopy-assisted craniectomy treatment for infant with nonsyndromic craniosynostosis

作　　者：张迪[1] 葛明[1] 冀园琦[1] 郑铁华[1] 孙骇浪[1] 邹哲伟[1] 李大鹏 蔡英杰 彭小娇 Zhang Di;Ge Ming;Ji Yuanqi;Zheng Tiehua;Sun Hailang;Zou Zhewei;Li Dapeng;Cai Yingjie;Peng Xiaojiao(Department of Neurosurgery,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院神经外科,100045

出　　处：《中华神经外科杂志》2020年第9期913-917,共5页Chinese Journal of Neurosurgery

摘　　要：目的探讨早期行神经内镜颅缝条状切除术后辅助矫形头盔治疗婴儿非综合征型颅缝早闭患儿的临床疗效。方法回顾性分析2018年7月至2019年7月首都医科大学附属北京儿童医院神经外科收治的8例非综合征型颅缝早闭患儿的临床资料,8例患儿月龄为(4.1±0.8)个月(3~5个月)。其中,矢状缝早闭5例,冠状缝早闭2例,多发颅缝早闭1例。8例患儿均于神经内镜下行颅缝条状切除术。术后要求佩戴矫形头盔治疗9~12个月,每日佩戴时间≥22 h。佩戴矫形头盔后定期门诊随访,进行头颅扫描建立三维模型,复查头颅形态并测量头围、头颅横径、头颅前后径、头颅指数(CI)、头颅不对称指数(CVAI)、头顶-鼻根-颏下点(V-N-G)夹角,同时留取手术前、后的头面部照片,以评估矫正效果。术前发育商评估异常的患儿术后复查发育商,以评估手术对神经系统发育的改善作用。结果 8例患儿中,2例行冠状缝条状切除术,5例行矢状缝条状切除术,1例行多发颅缝条状切除术。术后均未出现严重并发症。8例患儿的随访时间为(7.5±1.5)个月(6~10个月)。术后6个月随访时,2例单侧冠状缝早闭患儿的CVAI分别由3.062、3.341降至0.232、0.312,V-N-G角分别由167°和169°矫正为180°和178°,前斜头畸形及特征性颌面部畸形的矫正效果满意。5例矢状缝早闭患儿中,3例正确佩戴头盔的患儿头颅宽度增加、狭窄的双顶径增宽、CI恢复至0.80~0.89,矫正达到满意水平;2例矫正效果不满意,CI均<0.75。1例多发颅缝早闭患儿,头围由400.5 mm增至432.5 mm,三角形头颅逐渐膨隆圆润恢复正常外观,矫正效果满意。术前神经系统发育迟缓的1例多发颅缝早闭患儿,术后6个月复查发育商正常。结论初步观察发现,对于非综合征型颅缝早闭的患儿,早期行神经内镜下颅缝条状切除、术后辅助矫形头盔治疗既可矫正头颅畸形、颌面部畸形,也可一定程度上改善�Objective To summarize the clinical efficacy of early endoscopy-assisted craniectomy and postoperative cranial orthosis therapy for infants with nonsyndromic craniosynostosis.Methods A retrospective analysis was conducted on the clinical data of 8 children with non-syndromic craniosynostosis who were admitted to Department of Neurosurgery,Beijing Children′s Hospital,Capital Medical University from July 2018 to July 2019.The children were 4.1±0.8 months(3 to 5 months)old,and among them there were 5 cases of sagittal synostosis,2 cases of coronal craniosynostosis,and 1 case of multiple craniosynostosis.All 8 children underwent endoscopy-assisted craniectomy.After operation,the children underwent the therapy with orthopedic helmets for 9 to 12 months and≥22 h per day.Regular clinical follow-up was conducted after wearing an orthopedic helmet to scan the skull for establishing a 3D model,reviewing cerebral morphology and measuring head circumference,head transverse diameter,head anteroposterior diameter,cephalic index(CI),cranial vault asymmetry index(CVAI),vertex-nasion-gnathion(V-N-G)included angle,while taking photos of the head and face of preoperative and postoperative conditions to evaluate the correction effect.The infants with abnormal growth quotient before the surgery were reviewed after the surgery to assess the improvement of neurological development by the treatment.Results Among the 8 cases,2 adopted coronal suture strip resection,5 had sagittal suture strip resection,and 1 had multiple cranial suture strip resection.No serious complications occurred after operation.The follow-up time of the 8 patients was 7.5±1.5 months(6-10 months).At 6 months post operation,the CVAI of the two children with unilateral coronal suture synostosis decreased from 3.062 and 3.341 to 0.232 and 0.312,respectively.The VNG angle was corrected from 167°and 169°to 180°and 178°,respectively.The correction effect of cerebral deformity and typical maxillofacial deformity was satisfactory.Among the 5 children with sagittal

关 键 词：颅缝早闭 颌面畸形 婴儿 神经内镜 矫形外科固定装置 

分 类 号：R726.5[医药卫生—儿科]