Foster Kimberly A, Frim David M, McKinnon McKay
Chicago, Ill. From the Sections of Neurosurgery and Plastic and Reconstructive Surgery, University of Chicago, Comer Children's Hospital, and the Pritzker School of Medicine.
Plast Reconstr Surg. 2008 Mar;121(3):70e-76e. doi: 10.1097/01.prs.0000299393.36063.de.
The incidence of resynostosis after surgical release of synostotic suture(s) is not well reported. The authors examined cases of nonsyndromic and syndromic craniosynostosis treated with surgical repair and established the rate of reoperation for synostosis.
Charts were retrieved from 119 consecutive patients treated for craniosynostosis: 62 percent were boys, and 11 percent were treated for craniofacial dysostosis (Apert syndrome, n = 2; Crouzon syndrome, n = 4; Saethre-Chotzen syndrome, n = 5; and other, n = 2).
Eight patients (6.7 percent) underwent surgery for resynostosis [nonsyndromic, six of 106 (5.7 percent); syndromic, two of 13 (15.4 percent)]. Seventy-nine patients (66.4 percent) underwent primary surgery before 1 year of age. Analysis by age at primary operation yielded significantly lower resynostosis rates (p < 0.02) when patients younger than 1 year [two of 79 resynostosis cases (2.5 percent)] were compared with those older than 1 year [six of 40 resynostosis cases (15 percent)]. Further stratifications of age at initial operation did not yield significance for resynostosis. Four of eight patients who resynostosed had raised intracranial pressure, as indicated by lumbar puncture following the primary operation. A trend of increasing mean length of hospital stay, estimated blood loss, and operative time in the patients who eventually resynostosed was observed (data not significant).
Resynostosis rates were higher in syndromic than in nonsyndromic children for whom a single suture was involved. Analysis of age at primary operation showed an increase in resynostosis when the primary operation occurred after age 1 year. Evidence of increased intracranial pressure following primary surgery may suggest recurrence.
手术松解融合性缝线后再融合的发生率报道较少。作者研究了接受手术修复的非综合征性和综合征性颅缝早闭病例，并确定了颅缝再融合的再次手术率。
检索了119例连续接受颅缝早闭治疗患者的病历：62%为男性，11%接受颅面骨发育不全治疗（Apert综合征2例、Crouzon综合征4例、Saethre-Chotzen综合征5例及其他类型2例）。
8例患者（6.7%）因颅缝再融合接受手术[非综合征性，106例中的6例（5.7%）；综合征性，13例中的2例（15.4%）]。79例患者（66.4%）在1岁前接受了初次手术。按初次手术年龄分析，1岁以下患者[79例颅缝再融合病例中的2例（2.5%）]与1岁以上患者[40例颅缝再融合病例中的6例（15%）]相比，颅缝再融合率显著降低（p<0.02）。初次手术年龄的进一步分层对颅缝再融合无显著意义。8例颅缝再融合患者中有4例初次手术后腰椎穿刺显示颅内压升高。观察到最终颅缝再融合患者的平均住院时间、估计失血量和手术时间有增加趋势（数据无统计学意义）。
对于涉及单一缝线的综合征性儿童，颅缝再融合率高于非综合征性儿童。初次手术年龄分析显示，初次手术在1岁以后时颅缝再融合率增加。初次手术后颅内压升高的证据可能提示复发。
