New Haven, Conn.; Philadelphia, Pa.; and Krakow, Poland From the Department of Plastic Surgery, Yale University; Children's Hospital of Philadelphia, University of Pennsylvania; and Children's Hospital, Jagiellonian University.
Plast Reconstr Surg. 2011 Feb;127(2):792-801. doi: 10.1097/PRS.0b013e318200ab83.
Expansion of the posterior cranial vault more profoundly enlarges intracranial volume compared with the anterior region. Conventional vault remodeling techniques are limited by scalp forces and may relapse with supine positioning. The purpose of this study was to demonstrate the efficacy of posterior vault distraction and evaluate perioperative variables compared with conventional methods in syndromic children.
This was a retrospective analysis of consecutive children who underwent posterior vault expansion using distraction osteogenesis. Information was compiled regarding demographics, perioperative details, distraction protocol, and complications.
Eight children were identified, two boys and six girls. Diagnoses of Apert, Crouzon, Saethre-Chotzen, and Pfeiffer syndromes were present. Chiari malformation was present in two children. The posterior distraction procedure was undertaken at a mean of 21 months (range, 5 to 36 months). Mean operative time was 3.8 hours (range, 2.6 to 5 hours), blood loss averaged 487 ml (range, 300 to 2000 ml), and hospital stay was 3.25 days (range, 2 to 4 days). A latency period of 72 hours and rate of 2/3 mm/day was used in three patients, and 1 mm/day was used in five children. The mean advancement was 23 mm (range, 19 to 32 mm) and consolidation was 77 days (range, 42 to 100 days). One child experienced fracture of distraction arms during the activation period. Mean follow-up was 278 days (range, 90 to 548 days).
These preliminary findings indicate that posterior vault distraction is a viable technique with a favorable perioperative profile compared with conventional treatment. Posterior distraction can be the initial strategy with which to address intracranial pressure, allowing delay of definitive frontoorbital advancement until later in childhood.
与前颅区域相比，后颅穹窿的扩张更能显著增加颅内体积。传统的颅顶整形技术受头皮张力的限制，且可能会在仰卧位时复发。本研究旨在展示后颅穹窿牵张术的疗效，并与综合征患儿的常规方法比较围手术期各项变量。
这是一项回顾性分析，连续纳入接受牵张成骨术治疗的后颅穹窿扩张的患儿。收集人口统计学、围手术期细节、牵张方案和并发症等信息。
共确定了 8 例患儿，其中男 2 例，女 6 例。存在 Apert、Crouzon、Saethre-Chotzen 和 Pfeiffer 综合征的诊断。2 例患儿存在 Chiari 畸形。后颅牵张术平均在 21 个月时进行（5 至 36 个月）。平均手术时间为 3.8 小时（2.6 至 5 小时），平均失血量为 487ml（300 至 2000ml），平均住院时间为 3.25 天（2 至 4 天）。3 例患儿采用 72 小时潜伏期和 2/3mm/天的速率，5 例患儿采用 1mm/天的速率。平均推进距离为 23mm（19 至 32mm），融合时间为 77 天（42 至 100 天）。1 例患儿在激活期出现牵张臂骨折。平均随访时间为 278 天（90 至 548 天）。
这些初步结果表明，与传统治疗相比，后颅穹窿牵张术是一种可行的技术，具有良好的围手术期表现。后颅穹窿牵张术可以作为治疗颅内压的初始策略，允许将最终的额眶部推进术延迟到儿童后期进行。
