Yano Hiroki, Tanaka Katsumi, Sueyoshi Osamu, Takahashi Kunihiro, Hirata Reijiro, Hirano Akiyoshi
Department of Plastic and Reconstructive Surgery, Nagasaki University School of Medicine, Nagasaki, Japan.
Plast Reconstr Surg. 2006 Jan;117(1):193-200; discussion 201. doi: 10.1097/01.prs.0000194903.45939.b8.
Distraction osteogenesis has some advantages, such as less hazardous complications, less scarring, and fewer bone defects. However, it has not been fully accepted yet because of a unidirectional expansion along the distraction device. Because cranial expansion is limited by scalp tension and soft-tissue scarring, undercorrection of the cranium and relapse of the vault deformities have occasionally been seen on long-term follow-up. These patients also had so much bone defect that the donor bone was inadequate for immediate revisions, and dissection under the scalp was complicated.
The authors used distraction osteogenesis to treat 12 cases of craniosynostosis. Five patients were syndromic (two cases of Pfeiffer's syndrome, two cases of Crouzon's disease, and one case of Apert's syndrome), and seven were nonsyndromic (four cases of brachycephaly, two cases of scaphocephaly, and one case of plagiocephaly).
After only unidirectional expansion without vertical reduction, the shape of the cranium was satisfactorily improved, which might have been an illusion caused by the relative reduction attributed to the elongation by the distraction osteogenesis and, in brachycephaly, alteration of the patient's head position resulting from inclination of the facial plane by forehead advancement. However, in scaphocephaly, the unique deformity in the occipital and frontal regions remained after simple distraction. Distraction osteogenesis should be applied for a narrow cranium because the bone defect and scalp closure could pose problems. Radical reshaping should be used in cases of sufficient donor bone and scalp closure. Although additional surgery is unavoidable for device removal, minor revisions can be performed for revision of the irregularity at that time.
Except for prolonged treatment, based on minimally invasive operations, distraction cranioplasty might be applied extensively in cases of craniosynostosis.
牵张成骨具有一些优势，如并发症风险较低、瘢痕形成较少以及骨缺损较少。然而，由于其沿牵张装置的单向扩张，尚未被完全接受。由于颅骨扩张受头皮张力和软组织瘢痕形成的限制，在长期随访中偶尔会出现颅骨矫正不足和颅骨穹窿畸形复发的情况。这些患者还存在大量骨缺损，以至于供骨不足以立即进行修复，且头皮下的解剖操作复杂。
作者使用牵张成骨治疗12例颅缝早闭患者。5例为综合征性（2例Pfeiffer综合征、2例Crouzon病和1例Apert综合征），7例为非综合征性（4例短头畸形、2例舟状头畸形和1例斜头畸形）。
仅进行单向扩张而无垂直复位后，颅骨形状得到了令人满意的改善，这可能是牵张成骨导致的伸长所引起的相对复位以及短头畸形中由于前额前移导致面部平面倾斜而使患者头部位置改变所造成的一种假象。然而，在舟状头畸形中，单纯牵张后枕部和额部的独特畸形仍然存在。牵张成骨应适用于颅骨狭窄的情况，因为骨缺损和头皮闭合可能会带来问题。在有足够供骨和头皮闭合的情况下应采用根治性重塑。尽管移除装置时不可避免地需要额外手术，但届时可进行小的修复以纠正不规则之处。
除了治疗时间延长外，基于微创手术，牵张颅骨成形术可能会在颅缝早闭病例中得到广泛应用。
