Shah Manish N, Kane Alex A, Petersen J Dayne, Woo Albert S, Naidoo Sybill D, Smyth Matthew D
Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
J Neurosurg Pediatr. 2011 Aug;8(2):165-70. doi: 10.3171/2011.5.PEDS1128.
This study investigated the differences in effectiveness and morbidity between endoscopically assisted wide-vertex strip craniectomy with barrel-stave osteotomies and postoperative helmet therapy versus open calvarial vault reconstruction without helmet therapy for sagittal craniosynostosis.
Between 2003 and 2010, the authors prospectively observed 89 children less than 12 months old who were surgically treated for a diagnosis of isolated sagittal synostosis. The endoscopic procedure was offered starting in 2006. The data associated with length of stay, blood loss, transfusion rates, operating times, and cephalic indices were reviewed.
There were 47 endoscopically treated patients with a mean age at surgery of 3.6 months and 42 patients with open-vault reconstruction whose mean age at surgery was 6.8 months. The mean follow-up time was 13 months for endoscopic versus 25 months for open procedures. The mean operating time for the endoscopic procedure was 88 minutes, versus 179 minutes for the open surgery. The mean blood loss was 29 ml for endoscopic versus 218 ml for open procedures. Three endoscopically treated cases (6.4%) underwent transfusion, whereas all patients with open procedures underwent transfusion, with a mean of 1.6 transfusions per patient. The mean length of stay was 1.2 days for endoscopic and 3.9 days for open procedures. Of endoscopically treated patients completing helmet therapy, the mean duration for helmet therapy was 8.7 months. The mean pre- and postoperative cephalic indices for endoscopic procedures were 68% and 76% at 13 months postoperatively, versus 68% and 77% at 25 months postoperatively for open surgery.
Endoscopically assisted strip craniectomy offers a safe and effective treatment for sagittal craniosynostosis that is comparable in outcome to calvarial vault reconstruction, with no increase in morbidity and a shorter length of stay.
本研究探讨内镜辅助下采用桶状板截骨术的宽顶点条带颅骨切除术及术后头盔治疗与无头盔治疗的开放性颅骨穹窿重建术在矢状缝早闭治疗效果及发病率方面的差异。
2003年至2010年期间，作者前瞻性观察了89例12个月以下因孤立性矢状缝早闭接受手术治疗的儿童。2006年起开始提供内镜手术。回顾了与住院时间、失血量、输血率、手术时间和头指数相关的数据。
47例接受内镜治疗的患者手术时平均年龄为3.6个月，42例接受开放性颅骨穹窿重建术的患者手术时平均年龄为6.8个月。内镜治疗组平均随访时间为13个月，开放性手术组为25个月。内镜手术平均手术时间为88分钟，开放性手术为179分钟。内镜手术平均失血量为29毫升，开放性手术为218毫升。3例接受内镜治疗的病例（6.4%）接受了输血，而所有接受开放性手术的患者均接受了输血，平均每位患者输血1.6次。内镜手术平均住院时间为1.2天，开放性手术为3.9天。完成头盔治疗的内镜治疗患者中，头盔治疗的平均持续时间为8.7个月。内镜手术术后13个月的术前和术后平均头指数分别为68%和76%，开放性手术术后25个月为68%和77%。
内镜辅助条带颅骨切除术为矢状缝早闭提供了一种安全有效的治疗方法，其治疗效果与颅骨穹窿重建术相当，发病率无增加，住院时间更短。
