Goldstein Jesse A, Paliga James Thomas, Taylor Jesse A, Bartlett Scott P
From the *Department of Plastic Surgery, The University of Pittsburgh Medical School, Children's Hospital of Pittsburgh, Pittsburgh; †Division of Plastic Surgery, The Perelman School of Medicine at the University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
J Craniofac Surg. 2015 Jan;26(1):124-8. doi: 10.1097/SCS.0000000000001320.
Patients with syndromic craniosynostosis manifest midfacial hypoplasia often treated by midfacial advancement. Benefits of midfacial advancement by distraction osteogenesis have been well studied; little is known about the perioperative morbidity of these procedures, specifically relating to device selection. This study compares the perioperative complications between semiburied- and halo-type distraction osteogenesis of the midface. A retrospective review was performed on all patients with syndromic craniosynostosis who underwent midface distraction with semiburied- or halo-type external distractors. Demographic information and operative/postoperative course were reviewed. Complications were categorized as hardware-related, infectious, and either as major (requiring additional intervention) or minor (requiring medication only). Chi-squared and Fisher exact test were used to compare variables.From 1999 to 2012, a total of 54 patients underwent midface distraction osteogenesis, including 23 patients with Apert syndrome, 19 patients with Crouzon syndrome, 10 patients with Pfeiffer syndrome, and 2 patients with other craniofacial syndromes. Thirty-three patients underwent a total of 34 subcranial Le Fort III distraction procedures and 21 underwent 21 monobloc distraction procedures. The mean age during surgery was 8.0 (range, 4.0-17.7) years, whereas the mean time between distractor placement and removal was 102.9 days. Thirty procedures were performed with external halo-type distractors (18 Le Fort III and 12 monobloc distractions), whereas 25 were performed with buried midface distractors (16 Le Fort III and 9 monobloc distractions). There were no significant differences in diagnoses or interventions between the distraction devices. Of the 19 distractor-related complications, there were a total of 10 (18.2%) in the halo group including 5 (9.1%) requiring separate operative intervention as well as 9 (16.4%) in the buried distractor group including 6 (10.1%) requiring separate operative intervention. Major infections were more common in the buried distractor group (n = 8) compared with the halo distractor group (n = 3) (P = 0.048). There were 4 (7.3%) patients in the halo group who had malposition or transcranial pin migration related to postoperative positioning or falls and required operative repositioning. Frontofacial distraction is an important technique in patients with syndromic craniosynostosis. Higher rates of halo displacement requiring surgery are offset with lower rates of infections compared with buried distractors.
综合征性颅缝早闭患者常表现为面中部发育不全，通常采用面中部前移术进行治疗。牵张成骨术进行面中部前移的益处已得到充分研究；但对于这些手术的围手术期发病率，尤其是与器械选择相关的情况，人们了解甚少。本研究比较了面中部半埋式和 Halo 型牵张成骨术的围手术期并发症。对所有接受半埋式或 Halo 型外固定牵张器进行面中部牵张的综合征性颅缝早闭患者进行了回顾性研究。回顾了人口统计学信息和手术/术后过程。并发症分为与硬件相关、感染性，以及严重（需要额外干预）或轻微（仅需药物治疗）。采用卡方检验和 Fisher 精确检验比较变量。1999 年至 2012 年，共有 54 例患者接受了面中部牵张成骨术，其中包括 23 例 Apert 综合征患者、19 例 Crouzon 综合征患者、10 例 Pfeiffer 综合征患者和 2 例其他颅面综合征患者。33 例患者共接受了 34 次颅下 Le Fort III 型牵张手术，21 例患者接受了 21 次整块牵张手术。手术时的平均年龄为 8.0（范围 4.0 - 17.7）岁，而牵张器放置与取出之间的平均时间为 102.9 天。30 例手术使用了外部 Halo 型牵张器（18 例 Le Fort III 型和 12 例整块牵张），而 25 例使用了面中部埋入式牵张器（16 例 Le Fort III 型和 9 例整块牵张）。两种牵张器械在诊断或干预方面无显著差异。在 19 例与牵张器相关的并发症中，Halo 组共有 10 例（18.2%），其中 5 例（9.1%）需要单独进行手术干预；埋入式牵张器组有 9 例（16.4%），其中 6 例（10.1%）需要单独进行手术干预。与 Halo 牵张器组（n = 3）相比，埋入式牵张器组严重感染更为常见（n = 8）（P = 0.048）。Halo 组有 4 例（7.3%）患者因术后体位或跌倒导致错位或经颅针移位，需要进行手术复位。面中部牵张是综合征性颅缝早闭患者的一项重要技术。与埋入式牵张器相比，需要手术的 Halo 移位发生率较高，但感染率较低。
