Tovetjärn Robert, Maltese Giovanni, Kölby Lars, Kreiborg Sven, Tarnow Peter
Craniofacial Unit, Department of Plastic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
J Craniofac Surg. 2012 Jul;23(4):977-81. doi: 10.1097/SCS.0b013e31824e2bec.
Numerous surgical techniques for cranial reconstruction of patients with bicoronal synostosis have been suggested. The outcome is, however, still often suboptimal.
Since 2005, we have, at the Craniofacial Unit, Sahlgrenska University Hospital, Gothenburg, used a standardized surgical technique with advancement and remodeling of the forehead combined with spring distraction of the occipital area. The aim of the current study was to evaluate this operative technique. Eighteen consecutive patients (9 boys and 9 girls) with bicoronal synostosis operated on using this technique were identified. Sixteen patients had syndromic bicoronal synostosis, and 2 had nonsyndromic bicoronal synostosis. Cephalic index was obtained from three-dimensional computed tomography scans, and photographs were analyzed for aesthetic evaluation.
The preoperative calvarial shape was hyperbrachycephalic in all subjects. Postoperatively, the calvarial shape was, in general, much closer to the norm. The reduction in the mean cephalic index from the preoperative stage (94) to the 3-year follow-up (82) was statistically significant (P < 0.0001). The mean duration of surgery was 155 (SD, 32) minutes, with a mean perioperative bleeding of 237 (SD, 95) mL. The mean hospital stay was 6.3 (SD, 1.5) days, of which the mean intensive care unit stay was 1.6 (SD, 1.2) days. In 2 patients, one of the springs had to be reinserted because of postoperative dislocation. No other major complications were observed.
Spring-assisted cranioplasty for bicoronal synostosis is a safe technique, is less invasive than many other cranioplasties, and results in marked improvement in the calvarial shape.
对于双冠状缝早闭患者的颅骨重建，已经提出了多种手术技术。然而，其结果往往仍不尽人意。
自2005年以来，我们在哥德堡萨尔格伦斯卡大学医院颅面外科采用了一种标准化手术技术，即前额推进重塑联合枕部区域弹簧牵张。本研究的目的是评估该手术技术。确定了连续18例采用该技术进行手术的双冠状缝早闭患者（9名男孩和9名女孩）。16例患者患有综合征性双冠状缝早闭，2例患有非综合征性双冠状缝早闭。通过三维计算机断层扫描获得头指数，并对照片进行美学评估。
所有受试者术前颅骨形状均为短头畸形。术后，颅骨形状总体上更接近正常。从术前阶段（94）到3年随访（82），平均头指数的降低具有统计学意义（P < 0.0001）。平均手术时间为155（标准差，32）分钟，围手术期平均出血量为237（标准差，95）毫升。平均住院时间为6.3（标准差，1.5）天，其中平均重症监护病房住院时间为1.6（标准差，1.2）天。2例患者因术后弹簧脱位，其中一个弹簧需要重新植入。未观察到其他重大并发症。
弹簧辅助颅骨成形术治疗双冠状缝早闭是一种安全的技术，与许多其他颅骨成形术相比侵入性较小，并且能显著改善颅骨形状。
