Cho Byung Chae, Hwang Sung Kyu, Uhm Ki Il
Department of Plastic and Reconstructive Surgery, Kyungpook National University Hospital, Taegu, Korea.
J Craniofac Surg. 2004 Jan;15(1):135-44. doi: 10.1097/00001665-200401000-00034.
From January 2000 to December 2001, six patients with craniosynostosis were treated. Involved sutures were coronal sutures in three patients, coronal and metopic sutures in one patient, multiple sutures (brachycephaly and oxycephaly) in one patient, and multiple sutures with a cloverleaf skull deformity in one patient. The age distribution of the patients was 4 months to 3 years. Four were male, and two were female. A frontal craniotomy was performed in four patients with brachycephaly. In one patient with brachycephaly, the osteotomies were made across the nasofrontal junction, across the roof of the orbit, and along the lateral orbital wall. In one patient with a cloverleaf skull deformity, a frontal bone osteotomy was first performed 1 cm above the roof of the orbit. A supraorbital frontal bar was then made across the nasofrontal junction, across the roof of the orbit, and down to the lateral orbital wall. The frontal bone flap was repositioned to the supraorbital bar using absorbable miniplates and screws. Distraction was started 3 to 7 days after the operation at a distraction rate of 1 mm/d. The real duration of the first operation was 90 to 120 minutes, and the second operation to remove the device took 40 to 50 minutes to perform. The distracted length was 15 to 25 mm. The consolidation period was 3 to 5 weeks. The follow-up period was 6 months to 1 year. Postoperative three-dimensional computed tomography demonstrated reossification at the bone flap and advancement of the fronto-orbital area. After surgery, the cranial volume increased 22.7% on average compared with before surgery. The mean ratio of the anteroposterior length to the transverse length of the cranial vault was changed from 0.96 before surgery to 1.04 after surgery. In conclusion, the advantages of distraction osteogenesis of the cranial vault are that it offers a less invasive technique, a shorter operation time, easy care, and postoperative safety as a result of minimal dissection of the dura. Disadvantages are the limited possibility of initial reshaping and the necessity of one more operation for device removal.
2000年1月至2001年12月,对6例颅缝早闭患者进行了治疗。受累缝线在3例患者中为冠状缝,1例患者为冠状缝和额缝,1例患者为多条缝线(短头畸形和尖头畸形),1例患者为多条缝线合并三叶形颅骨畸形。患者的年龄分布为4个月至3岁。4例为男性,2例为女性。4例短头畸形患者行额部开颅手术。1例短头畸形患者的截骨术跨越鼻额交界处、眶顶和眶外侧壁。1例三叶形颅骨畸形患者,首先在眶顶上方1 cm处行额骨截骨术。然后制作一个眶上额杆,跨越鼻额交界处、眶顶并向下至眶外侧壁。使用可吸收微型钢板和螺钉将额骨瓣重新定位到眶上杆上。术后3至7天开始牵引,牵引速度为1 mm/d。第一次手术的实际时长为90至120分钟,第二次取出装置的手术用时40至50分钟。牵引长度为15至25 mm。巩固期为3至5周。随访期为6个月至1年。术后三维计算机断层扫描显示骨瓣处重新骨化以及额眶区域前移。术后,颅骨体积平均比术前增加了22.7%。颅顶前后径与横径的平均比值从术前的0.96变为术后的1.04。总之,颅顶牵张成骨的优点是提供了一种侵入性较小的技术、较短的手术时间、易于护理以及由于对硬脑膜的最小剥离而具有术后安全性。缺点是初始塑形的可能性有限以及需要再进行一次取出装置的手术。