Derderian Christopher A, Wink Jason D, McGrath Jennifer L, Collinsworth Amy, Bartlett Scott P, Taylor Jesse A
Dallas, Texas; Philadelphia, Pa.; and Chicago, Ill. From the University of Texas Southwestern Medical Center; the University of Pennsylvania Perelman School of Medicine; and Northwestern University Feinberg School of Medicine.
Plast Reconstr Surg. 2015 Jun;135(6):1665-1672. doi: 10.1097/PRS.0000000000001294.
Posterior cranial vault distraction osteogenesis has recently been introduced to treat patients with multisuture syndromic craniosynostosis and is believed to provide greater gains in intracranial volume. This study provides volumetric analysis to determine the gains in intracranial volume produced by this modality.
This was a two-center retrospective study of preprocedure and postprocedure computed tomography scans of two groups of 15 patients each with syndromic multisuture craniosynostosis treated with either fronto-orbital advancement or posterior cranial vault distraction osteogenesis. Scan data were analyzed volumetrically with Mimics software. Volumetric gains attributable to growth between scans were controlled for.
The mean advancements were 12.5 mm for fronto-orbital advancement and 24.8 mm for distraction osteogenesis. The mean difference in volume between the preoperative and postoperative scans was 144 cm(3) for fronto-orbital advancement and 274 cm(3) for (p = 0.009). After controlling for growth, the corrected mean volume difference was 66 cm(3) for fronto-orbital advancement and 142 cm(3) for distraction osteogenesis (p = 0.0017). The corrected mean volume difference per millimeter of advancement was 4.6 cm(3) for fronto-orbital advancement and 5.8 cm(3) for distraction (p = 0.357).
In this retrospective study, posterior cranial vault distraction osteogenesis provided statistically greater intracranial volume expansion than fronto-orbital advancement. The volume gains per millimeter advancement were similar between groups, with a trend toward greater gains per millimeter with distraction osteogenesis. Gradual expansion of the overlying soft tissues with posterior cranial vault distraction osteogenesis appears to be the primary mechanism for greater volume gains with this technique.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
后颅穹窿牵张成骨术最近被用于治疗多缝综合征性颅缝早闭患者，据信该方法能使颅内容积有更大增加。本研究进行容积分析，以确定这种治疗方式所产生的颅内容积增加量。
这是一项双中心回顾性研究，对两组各15例综合征性多缝颅缝早闭患者进行术前和术后计算机断层扫描，一组采用额眶前移术，另一组采用后颅穹窿牵张成骨术。使用Mimics软件对扫描数据进行容积分析。对扫描之间因生长导致的容积增加进行了控制。
额眶前移术的平均前移量为12.5毫米，牵张成骨术的平均前移量为24.8毫米。额眶前移术术前和术后扫描的平均容积差异为144立方厘米，牵张成骨术为274立方厘米（p = 0.009）。在控制生长因素后，额眶前移术校正后的平均容积差异为66立方厘米，牵张成骨术为142立方厘米（p = 0.0017）。额眶前移术每毫米前移的校正平均容积差异为4.6立方厘米，牵张成骨术为5.8立方厘米（p = 0.357）。
在这项回顾性研究中，后颅穹窿牵张成骨术在统计学上比额眶前移术能提供更大程度的颅内容积扩张。两组每毫米前移的容积增加量相似，牵张成骨术每毫米有更大增加量的趋势。后颅穹窿牵张成骨术使覆盖的软组织逐渐扩张似乎是该技术实现更大容积增加的主要机制。
临床问题/证据水平：治疗性研究，III级。
