Li Jing, Gerety Patrick A, Xu Wen, Bartlett Scott P, Taylor Jesse A
Department of Surgery, The Children's Hospital of Philadelphia, The University of Pennsylvania, Philadelphia, PA.
J Craniofac Surg. 2016 Jul;27(5):1165-9. doi: 10.1097/SCS.0000000000002795.
There is a growing literature on the advantages of posterior cranial vault distraction osteogenesis (PVDO) in infants, particularly those with syndromic and multisuture craniosynostosis. This study aims to compare perioperative outcomes of PVDO in older patients to those of infants. A prospective craniofacial database was queried for patients aged 5 and older undergoing PVDO; controls were diagnosis-matched infants. Demographic, perioperative, and distraction data was compared using a 2-sample t test and Fisher exact test.Twenty patients met inclusion criteria, and all had syndromic craniosynostosis. Mean age was 9.2 years for the older group, and 0.7 years for the younger. Older children had less weight-based blood loss (mean 58.6 ± 38.8 versus 14.6 ± 7.0 cc/kg, control versus older, P = 0.0092) and weight-based transfusion (mean 70.1 ± 37.2 versus 21.2 ± 9.9 cc/kg, control versus older, P = 0.0023); other perioperative variables were similar including duration of surgery, length of stay, distance distracted, time in consolidation, and length of follow-up. All patients in both groups successfully completed PVDO, and all older patients had resolution of papilledema and/or headaches. One from each group developed a wound infection that was treated with oral antibiotics.Posterior cranial vault distraction osteogenesis is a safe and efficacious for cranial vault expansion in syndromic craniosynostosis, with similar perioperative outcomes in older children as compared to infants. Posterior cranial vault distraction osteogenesis may be a reasonable alternative in older syndromic patients with acceptable frontal morphology and concerns for increased intracranial pressure.
关于婴儿后颅穹窿牵张成骨术（PVDO）的优势，尤其是患有综合征性和多缝颅缝早闭症婴儿的优势，相关文献越来越多。本研究旨在比较老年患者与婴儿PVDO的围手术期结果。对一个前瞻性颅面数据库进行查询，以获取年龄在5岁及以上接受PVDO的患者；对照组为诊断匹配的婴儿。使用双样本t检验和Fisher精确检验比较人口统计学、围手术期和牵张数据。20名患者符合纳入标准，且均患有综合征性颅缝早闭症。老年组的平均年龄为9.2岁，年轻组为0.7岁。年龄较大的儿童基于体重的失血量较少（平均58.6±38.8对比14.6±7.0 cc/kg，对照组对比老年组，P = 0.0092）以及基于体重的输血量较少（平均70.1±37.2对比21.2±9.9 cc/kg，对照组对比老年组，P = 0.0023）；其他围手术期变量相似，包括手术持续时间、住院时间、牵张距离、骨愈合时间和随访时间。两组所有患者均成功完成PVDO，所有老年患者的视乳头水肿和/或头痛均得到缓解。每组各有1例发生伤口感染，经口服抗生素治疗。后颅穹窿牵张成骨术对于综合征性颅缝早闭症的颅穹窿扩张是安全有效的，与婴儿相比，老年儿童的围手术期结果相似。对于额部形态可接受且担心颅内压升高的老年综合征患者，后颅穹窿牵张成骨术可能是一种合理的选择。
