Schmelzer Rodney E, Perlyn Chad A, Kane Alex A, Pilgram Thomas K, Govier Daniel, Marsh Jeffrey L
St. Louis, Mo. From the Division of Plastic Surgery and the Cleft Palate and Craniofacial Deformities Institute, St. Louis Children's Hospital and Washington University School of Medicine, and St. John's Medical Center, Kids Plastic Surgery.
Plast Reconstr Surg. 2007 Apr 15;119(5):1546-1552. doi: 10.1097/01.prs.0000256067.42651.30.
The authors tested the premise that there are four distinctive patterns of calvarial dysmorphology in nonsyndromic sagittal craniosynostosis that can be reproducibly recognized.
Twenty-nine computed tomographic scan data sets of infants met the following criteria: nonsyndromic sagittal craniosynostosis, age younger than 12 months, and satisfactory computed tomographic data. Osseous reformations were constructed in the anteroposterior, right lateral, and vertex projections for each patient. From these images, four templates--coronal constriction, occipital protuberance, bifrontal bossing, and bitemporal protrusion--were selected as prototypes of the specific dysmorphologies the authors observed in patients with sagittal craniosynostosis. Four residents assigned the 29 calvarial image sets to one of the four templates or, if they were unable to do so, to the group "other." The sortings were then assessed for clustering. The same patient computed tomographic data were reformatted with osseous color images, which were then sorted according to template group by eight senior craniofacial surgeons, who repeated the task approximately 3 months later. The repeatability and assessment of clustering of image sets using the templates was evaluated.
In the residents' pilot study, 41 percent (12 of 29) of patients had 100 percent concordance rates, 31 percent (nine of 29) had 75 percent concordance, 24 percent (seven of 29) had 50 percent, and 3 percent (one of 29) had 25 percent concordance. In summary, greater than 70 percent of the patient image sets could be sorted with at least 75 percent concordance by residents. In the senior surgeons' study, 90 percent of patients could be identified as falling into two of five possible groups. Senior raters demonstrated nearly 70 percent repeatability between sortings.
These findings support the hypothesis that there are identifiable and reproducible patterns of varying calvarial dysmorphology in patients with sagittal craniosynostosis.
作者检验了如下前提，即非综合征性矢状缝早闭存在四种可重复识别的颅骨畸形独特模式。
29例婴儿的计算机断层扫描数据集符合以下标准：非综合征性矢状缝早闭、年龄小于12个月且计算机断层扫描数据良好。为每位患者构建前后位、右侧位和头顶位的骨重建图像。从这些图像中，选择四个模板——冠状缝狭窄、枕骨隆突、双额隆突和双颞突出——作为作者在矢状缝早闭患者中观察到的特定畸形的原型。四名住院医师将29个颅骨图像集归入四个模板之一，若无法归类则归入“其他”组。然后评估分类的聚类情况。用骨彩色图像对同一患者的计算机断层扫描数据进行重新格式化，然后由八位资深颅面外科医生根据模板组进行分类，他们在大约3个月后重复此项任务。评估了使用模板对图像集进行聚类的可重复性。
在住院医师的初步研究中，41%（29例中的12例）患者的一致性率为100%，31%（29例中的9例）为75%，24%（29例中的7例）为50%，3%（29例中的1例）为25%。总之，住院医师可将超过70%的患者图像集以至少75%的一致性进行分类。在资深外科医生的研究中，90%的患者可被归入五个可能组中的两个组。资深评估者的分类之间显示出近70%的可重复性。
这些发现支持了如下假设，即矢状缝早闭患者存在可识别且可重复的不同颅骨畸形模式。
