Cohen Steven R, Cho David C, Nichols Sharon L, Simms Catherine, Cross Keith P, Burstein Fernando D
University of California, San Diego, USA.
Plast Reconstr Surg. 2004 Sep 15;114(4):841-7; discussion 848-9. doi: 10.1097/01.prs.0000132854.14237.a8.
The purpose of this study was to prospectively determine the neurodevelopmental effects associated with single-suture, nonsyndromic craniosynostosis before and after surgery. Children diagnosed with single-suture craniosynostosis were evaluated by a psychologist using the Bayley Scales of Infant Development-Second Edition (BSID-II) within 2 months before and again 1 year after surgical correction. The BSID-II is a widely used measure of infant cognitive and motor development. The scale consists of three parts, the Mental Developmental Index (MDI), the Psychomotor Developmental Index (PDI), and the Behavior Rating Scale. The MDI and PDI yield age-standard scores (mean, 100; SD, 16). The children ranged in age from 2.5 to 10 months at the time of the craniofacial reconstruction (average age, 5.9 months). Metopic synostosis was diagnosed in 23 percent, sagittal synostosis in 45 percent, and unilateral coronal synostosis in 32 percent of patients. Twenty-two patients were evaluated preoperatively, of whom 15 patients were evaluated postoperatively. Mean baseline BSID-II scores revealed a mild delay in mental and motor scores (MDI, 82.3; PDI, 79.5). Mean postoperative BSID-II scores still revealed a mild delay in mental scores but significantly improved motor scores (MDI, 79.3; PDI, 89.3). Of the 15 children, four (27 percent) had BSID-II evaluations that were in the average range for all scales and nine infants (60 percent) had at least one MDI or PDI score in the significantly delayed range (<70). Among children with single-suture nonsyndromic craniosynostosis, mean Bayley scores indicated mild baseline deficits in both mental and motor scores. After surgical treatment, improvement was seen in the motor scale. It appears from this sample that neurodevelopmental abnormalities may be present in children with single-suture synostosis, and some may persist at 1 year of follow-up.
本研究的目的是前瞻性地确定单缝、非综合征性颅缝早闭手术前后的神经发育影响。诊断为单缝颅缝早闭的儿童在手术矫正前2个月内和术后1年再次由心理学家使用贝利婴儿发展量表第二版（BSID-II）进行评估。BSID-II是一种广泛使用的婴儿认知和运动发育测量工具。该量表由三个部分组成，即心理发展指数（MDI）、心理运动发展指数（PDI）和行为评定量表。MDI和PDI产生年龄标准化分数（平均值为100；标准差为16）。颅面重建时，儿童年龄在2.5至10个月之间（平均年龄为5.9个月）。23%的患者诊断为额缝早闭，45%为矢状缝早闭，32%为单侧冠状缝早闭。22例患者术前接受评估，其中15例患者术后接受评估。平均基线BSID-II评分显示心理和运动评分轻度延迟（MDI为82.3；PDI为79.5）。术后平均BSID-II评分仍显示心理评分轻度延迟，但运动评分显著改善（MDI为79.3；PDI为89.3）。在这15名儿童中，4名（27%）儿童的BSID-II评估在所有量表的平均范围内，9名婴儿（60%）至少有一项MDI或PDI评分在显著延迟范围内（<70）。在单缝非综合征性颅缝早闭儿童中，平均贝利评分表明心理和运动评分在基线时均有轻度缺陷。手术治疗后，运动量表有改善。从这个样本来看，单缝早闭儿童可能存在神经发育异常，且部分异常在随访1年时可能持续存在。
