Mann Robert J, Fahrenkopf Matthew P, Burton Michael, Girotto John, Polley John
*Michigan State University College of Human Medicine †Grand Rapids Medical Education Partners Plastic and Reconstructive Surgery Residency ‡Helen DeVos Children's Hospital Pediatric Plastic Surgery, Grand Rapids, MI §Advanced Dermatology and Cosmetic Surgery, Clearwater, FL.
J Craniofac Surg. 2017 Nov;28(8):2108-2112. doi: 10.1097/SCS.0000000000004179.
Deformities of the cranium in patients with nonsyndromic single-suture synostosis occur because of growth restriction at fused sutures and growth over compensation at normal sutures. Traditional surgery includes ostectomies of the synostotic suture to release these restricted areas and osteotomies to enable immediate cranial remodeling. In the process of reshaping the cranium, traditional approaches usually involve obliteration of both the normal functioning suture and the pathologic suture. The directive growth approach (DGA) is a new, simpler, more natural way to repair deformities caused by single-suture cranial synostosis. The DGA works by reversing the original deforming forces by temporarily restricting growth in areas of over compensation and forcing growth in areas of previous synostotic restriction. Most importantly, it preserves a normal functioning suture to allow for improved future cranial growth. Eighteen consecutive nonsyndromic patients with unilateral coronal synostosis were used to illustrate the efficacy of the DGA. Ten patients who underwent DGA treatment were compared with a control group of 8 patients treated with traditional frontal orbital advancement. Postoperative three-dimensional computed tomography (CT) comparison measurements were taken, including bilateral vertical and transverse orbital dimensions, lateral orbital rim to external auditory canal, and forehead measurements from the superior aspect of the orbital rim to the pituitary fossa. The traditional treatment group showed absence of the coronal sutures bilaterally on long-term CT scans. The DGA group showed normal coronal sutures on the unaffected sides. Postoperative CT measurements showed no statistical difference between the 2 techniques (P < 0.05).
非综合征性单缝早闭患者的颅骨畸形是由于融合缝处生长受限以及正常缝处生长过度代偿所致。传统手术包括对早闭缝进行截骨以松解这些受限区域，并进行截骨术以实现即刻颅骨重塑。在颅骨重塑过程中，传统方法通常涉及使正常功能的缝和病理性缝均闭合。导向生长方法（DGA）是一种全新、更简单、更自然的修复单缝颅骨早闭所致畸形的方法。DGA通过暂时限制过度代偿区域的生长并促使先前早闭受限区域生长来逆转原始变形力。最重要的是，它保留了正常功能的缝，以促进未来颅骨更好地生长。连续18例非综合征性单侧冠状缝早闭患者用于说明DGA的疗效。将10例行DGA治疗的患者与8例接受传统额眶前移治疗的患者组成的对照组进行比较。术后进行三维计算机断层扫描（CT）对比测量，包括双侧垂直和横向眶径、眶外侧缘至外耳道距离，以及从眶缘上缘至垂体窝的额部测量。长期CT扫描显示，传统治疗组双侧冠状缝消失。DGA组未受影响侧冠状缝正常。术后CT测量结果显示两种技术之间无统计学差异（P<0.05）。
