Oxford and Southampton, United Kingdom From the Oxford Craniofacial Unit, Oxford University Hospitals NHS Trust; the Oxford National Institute for Health and Research Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; and the MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital.
Plast Reconstr Surg. 2014 Nov;134(5):775e-786e. doi: 10.1097/PRS.0000000000000633.
Aims of surgical correction for isolated sagittal synostosis are functional and aesthetic. Multiple surgical techniques exist; however, reliable assessment of aesthetic outcome is poorly documented, limiting direct comparisons. The pinched appearance of the temporal regions is particularly challenging to correct. A visual analogue scale was designed to grade skull shape in patients who had total or subtotal calvarial remodeling for isolated sagittal synostosis.
Twenty-two assessors graded preoperative and postoperative photographs from 42 consecutive cases of sagittal synostosis under a single surgeon. Five aspects were graded (i.e., narrow elongated skull, frontal bossing, temporal pinching, occipital bullet, and overall shape) from 0 (normal) to 100 (severe). Interobserver and intraobserver agreement were analyzed by calculating within-subject standard deviation, coefficient of variation, and intraclass correlation coefficient. Linear regression analysis determined predictors of outcome.
Surgery improved outcome dramatically across all five aspects of skull shape, with a 72.6 to 76.4 percent decrease in severity score. Improvements in severity score were greater after total calvarial remodeling, and type of calvarial remodeling (total versus subtotal) was an independent predictor of outcome in all aspects of skull shape (p≤0.001). Temporal pinching was improved in a subset of patients who also had onlay bone grafts in this region.
Calvarial remodeling is a powerful technique for improving skull shape. A panel can detect gross and subtle aesthetic changes after surgical correction of sagittal synostosis using a visual analogue scale, with moderate interobserver and intraobserver agreement. This provides a tool for future outcome assessment.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
矢状缝早闭的手术矫正目的是功能性和美观性。存在多种手术技术；然而，对美学结果的可靠评估记录很少，限制了直接比较。颞区的夹捏外观尤其难以矫正。设计了一种视觉模拟量表来对接受完全或部分颅骨重塑的孤立矢状缝早闭患者的颅骨形状进行分级。
22 名评估者对 42 例连续矢状缝早闭病例在单一外科医生下的术前和术后照片进行分级。从 0（正常）到 100（严重）对 5 个方面（即狭长的颅骨、额骨突出、颞部夹捏、枕部子弹头和整体形状）进行分级。通过计算个体内标准差、变异系数和组内相关系数来分析观察者间和观察者内的一致性。线性回归分析确定了结果的预测因素。
手术显著改善了颅骨形状的所有 5 个方面，严重程度评分降低了 72.6%至 76.4%。完全颅骨重塑后的改善程度更大，颅骨重塑的类型（完全与部分）是所有颅骨形状方面结果的独立预测因素（p≤0.001）。在该区域接受骨瓣移植的部分患者中，颞部夹捏得到了改善。
颅骨重塑是改善颅骨形状的有力技术。使用视觉模拟量表，一个小组可以检测到矢状缝早闭手术后颅骨形状的明显和微妙的美学变化，观察者间和观察者内的一致性中等。这为未来的结果评估提供了一种工具。
临床问题/证据水平：治疗，IV。
