Gangopadhyay Noopur, Shah Manjool, Skolnick Gary B, Patel Kamlesh B, Naidoo Sybill D, Woo Albert S
From the *Department of Surgery, Division of Plastic and Reconstructive Surgery, Cleft Palate-Craniofacial Institute, Washington University in Saint Louis School of Medicine, Saint Louis, MO; and †Casey Eye Institute at Oregon Health & Science University, Portland, OR.
J Craniofac Surg. 2014 Jul;25(4):1226-9. doi: 10.1097/SCS.0000000000000875.
The esthetic success of sagittal synostosis reconstruction is measured by cephalic index (CI). This limited measure does not fully account for the abnormal head shape in sagittal synostosis. In this retrospective study, we investigate a new objective measure, point of maximum width (PMW) of the skull from a vertex view, to determine where the head is widest for children with sagittal synostosis as compared with normal controls. Preoperative computed tomography (CT) scans of 27 children with sagittal synostosis and 14 postoperative CT scans at least 8 months after surgery were obtained. Normal CT scans were matched for age, sex, and race. Three-dimensional renderings were standardized for orientation. Mean (SE) PMW in patients with sagittal synostosis was 53% (1%) compared with 57% (1%) in controls (P < 0.001). Mean (SE) CI in patients with sagittal synostosis was 66.8% (0.8%) compared with 83.3% (1.0%) in controls (P < 0.001). The correlation between PMW and CI was weak in both controls (r2 = 0.002, P = 0.824) and uncorrected cases (r2 = 0.083, P = 0.145). After surgical correction, both CI and PMW significantly improved. Mean (SE) PMW in patients after surgical release of sagittal synostosis was 58% (1%) compared with 58% (1%) in controls (P = 0.986). The PMW is not a surrogate for CI but is a novel, valid measure of skull shape, which aids in quantifying the widest region of the skull. It is significantly more anterior in children with sagittal synostosis and exhibits a consistent posterior shift along the cranium after surgery, showing no difference compared with healthy children.
矢状缝早闭重建术的美学成功通过头指数（CI）来衡量。这一有限的指标并不能完全解释矢状缝早闭时异常的头部形状。在这项回顾性研究中，我们研究了一种新的客观指标，即从头顶视图测量颅骨的最大宽度点（PMW），以确定矢状缝早闭患儿与正常对照组相比头部最宽的位置。获取了27例矢状缝早闭患儿的术前计算机断层扫描（CT）图像以及术后至少8个月的14例CT扫描图像。正常CT扫描图像根据年龄、性别和种族进行匹配。三维重建图像进行了定向标准化。矢状缝早闭患者的平均（标准误）PMW为53%（1%），而对照组为57%（1%）（P<0.001）。矢状缝早闭患者的平均（标准误）CI为66.8%（0.8%），而对照组为83.3%（1.0%）（P<0.001）。在对照组（r2 = 0.002，P = 0.824）和未矫正病例组（r2 = 0.083，P = 0.145）中，PMW与CI之间的相关性均较弱。手术矫正后，CI和PMW均显著改善。矢状缝松解术后患者的平均（标准误）PMW为58%（1%），与对照组的58%（1%）相比（P = 0.986）。PMW不是CI的替代指标，而是一种新的、有效的颅骨形状测量指标，有助于量化颅骨最宽区域。它在矢状缝早闭患儿中明显更靠前，术后沿颅骨一致向后移位，与健康儿童相比无差异。
