Alford Jake, Derderian Christopher A, Smartt James M
Department of Plastic Surgery, University of Texas Southwestern, Dallas, TX.
J Craniofac Surg. 2018 Jul;29(5):1199-1207. doi: 10.1097/SCS.0000000000004509.
Unicoronal synostosis (UCS) remains one of the most difficult craniofacial conditions to treat. This review attempts to consolidate all existing literature from the past 25 years that has investigated surgical treatment of nonsyndromic UCS. Additional attention is paid to specific areas of controversy regarding surgical management and evaluation of UCS: outcomes of fronto-orbital advancement (FOA) versus endoscopic strip craniectomy (ESC), emergence of spring-associated cranioplasty for craniosynostosis, and morphologic assessment metrics.
A literature search from 1992 to 2017 was performed with a defined search strategy and manual screening process. About 24 studies were included in the final review.
There is inconsistency among studies in measuring outcomes. Despite wide utilization, FOA produces mixed results, especially when looking at long-term outcomes. Preliminary data suggest advantages to using ESC over FOA with regard to facial symmetry, postoperative strabismus, and operating time. Distraction osteogenesis has long been utilized in Asia and is now being actively studied in the United States. Data on spring-assisted cranioplasty are lacking. Long-term results at skeletal maturity for many of these techniques are lacking.
Despite some promising results, methods of measurement are inconsistent and long-term data are lacking. All future research in this area would benefit from consistent and standardized reporting of data, including perioperative statistics and reproducible 3-dimensional computed tomography craniofacial measurements. Additionally, no definitive recommendations can be made until data at skeletal maturity are studied, and all studies would benefit from long-term follow-up data.
单冠状缝早闭（UCS）仍然是最难治疗的颅面疾病之一。本综述旨在整合过去25年中所有研究非综合征性UCS手术治疗的现有文献。此外，还特别关注了UCS手术管理和评估方面存在争议的特定领域：额眶前移术（FOA）与内镜下条带颅骨切除术（ESC）的疗效、用于颅缝早闭的弹簧相关颅骨成形术的出现以及形态学评估指标。
采用明确的检索策略和人工筛选流程，对1992年至2017年的文献进行检索。最终纳入综述的研究约有24项。
各研究在测量结果方面存在不一致性。尽管FOA应用广泛，但其结果参差不齐，尤其是长期结果。初步数据表明，在面部对称性、术后斜视和手术时间方面，ESC比FOA更具优势。牵引成骨术在亚洲长期以来一直被应用，目前在美国也正在积极研究。关于弹簧辅助颅骨成形术的数据匮乏。许多这些技术在骨骼成熟时的长期结果也缺乏。
尽管取得了一些有前景的结果，但测量方法不一致且缺乏长期数据。该领域未来的所有研究都将受益于一致且标准化的数据报告，包括围手术期统计数据和可重复的三维计算机断层扫描颅面测量数据。此外，在研究骨骼成熟时的数据之前，无法给出明确的建议，所有研究都将受益于长期随访数据。
