Sauerhammer Tina M, Seruya Mitchel, Basci Deniz, Rogers Gary F, Keating Robert F, Boyajian Michael J, Oh Albert K
From the Division of Plastic and Reconstructive Surgery, Children's National Medical Center, Washington, DC.
J Craniofac Surg. 2014 Jul;25(4):1341-5. doi: 10.1097/SCS.0000000000000810.
Ectocortical resorbable plate fixation has become a standard method of fixation during fronto-orbital advancement (FOA) in young children. Plate hydrolysis occurs slowly and can cause visible prominences, sterile abscesses, and osseous depressions that can persist after complete resorption. Although endocortical placement avoids contour issues, the safety and effectiveness of this technique are undocumented.
A review of our prospectively collected craniofacial database was performed. All patients undergoing FOA by a single craniofacial team at a single institution from 1997 to 2011 were examined. Inclusion criteria were as follows: (1) unicoronal, bicoronal, or metopic synostosis; (2) resorbable endocortical fixation of the bandeau; and (3) follow-up for 1 year or longer. Evaluation included patient demographic data, postoperative clinical course, and computed tomography imaging when available.
Seventy-three patients met the inclusion criteria. Fusion involved the unicoronal (n = 26), bicoronal (n = 19), and metopic (n = 28) sutures. Mean age at operation was 8.3 months (range, 2.7-35.5 mo), and follow-up was 4.5 years (range, 1.0-9.9 y). No endocortical or ectocortical sterile abscesses were documented in our series. Postoperative complications included hematoma (n = 2), infection (n = 2), wound breakdown (n = 3), cerebral contusion (n = 2), and cerebrospinal fluid leak (n = 1); none of these issues were related to endocortical absorbable fixation. Fifty-eight patients (80%) were categorized as Whitaker classification I/II; and 15 patients (20%), Whitaker classification III/IV. Postoperative computed tomography (mean follow-up, 4.6 y) was obtained in 34 patients (47%). All plates were completely resorbed, and there were no bone or soft tissue irregularities in the region where the plates were placed.
Endocortical resorbable fixation is a safe and effective method of osseous stabilization during FOA for craniosynostosis in young children.
在幼儿额眶前移术（FOA）中，皮质外可吸收板固定已成为一种标准的固定方法。钢板水解过程缓慢，可导致明显的隆起、无菌性脓肿和骨质凹陷，这些情况在完全吸收后仍可能持续存在。尽管皮质内放置可避免外形问题，但该技术的安全性和有效性尚无文献记载。
对我们前瞻性收集的颅面数据库进行了回顾。检查了1997年至2011年在单一机构由单一颅面团队进行FOA手术的所有患者。纳入标准如下：（1）单冠状缝、双冠状缝或额缝早闭；（2）可吸收皮质内固定带；（3）随访1年或更长时间。评估包括患者人口统计学数据、术后临床过程以及如有可用的计算机断层扫描成像。
73例患者符合纳入标准。融合涉及单冠状缝（n = 26）、双冠状缝（n = 19）和额缝（n = 28）。手术时的平均年龄为8.3个月（范围2.7 - 35.5个月），随访时间为4.5年（范围1.0 - 9.9年）。我们的系列中未记录到皮质内或皮质外无菌性脓肿。术后并发症包括血肿（n = 2）、感染（n = 2）、伤口裂开（n = 3）、脑挫伤（n = 2）和脑脊液漏（n = 1）；这些问题均与皮质内可吸收固定无关。58例患者（80%）被归类为惠特克分类I/II级；15例患者（20%）为惠特克分类III/IV级。34例患者（47%）进行了术后计算机断层扫描（平均随访4.6年）。所有钢板均完全吸收，钢板放置区域无骨质或软组织不规则情况。
皮质内可吸收固定是幼儿颅缝早闭FOA手术中一种安全有效的骨质稳定方法。
