Sunaga Ataru, Sugawara Yasushi, Kamochi Hideaki, Gomi Akira, Uda Hirokazu, Sarukawa Shunji, Yoshimura Kotaro
Department of Pediatric Plastic Surgery, Jichi Children's Medical Center Tochigi.
Department of Plastic Surgery, Jichi Medical University, Shimotsuke.
J Craniofac Surg. 2019 Jan;30(1):57-60. doi: 10.1097/SCS.0000000000004927.
Previously, the authors developed a new method of distraction osteogenesis for the treatment of craniosynostosis, multidirectional cranial distraction osteogenesis (MCDO). The purpose of this study is to review the authors' experience of MCDO for remodeling of the anterior cranium in the patients of craniosynostosis.
Forty-five patients with craniosynostosis underwent MCDO for anterior cranial remodeling from 2003 to 2017. The ages of the patients ranged from 8 to 72 months (mean: 23.9 months, median: 13 months). The involved sutures included the bicoronal suture in 14 patients, unicoronal suture in 4 patients, sagittal suture in 14 patients, metopic suture in 2 patient, and multiple sutures in 10 patients.
An improvement of in cranial shape was achieved in 40 patients. In 1 patient, intraoperative massive bleeding forced us finishing the procedure before completing the planned osteotomy. Transient cerebrospinal fluid leakage occurred in 3 patients during the activation phase but recovered with conservative therapy. The mean blood transfusion was 25.5 mL/kg. The phase of activation ranged from 7 to 17 days (mean, 10.6 days) and the consolidation period ranged from 16 to 67 days (mean, 32.4 days). Loosening of traction pins occurred in 7 patients, resulting in undercorrection in 2 patients, and loosening of anchor pins occurred in 19 patients, resulting in acceleration of removal of the devices in 7 patients.
Multidirectional cranial distraction osteogenesis was effective and has several advantages over the conventional procedures. Therefore, the authors conclude that MCDO will be a useful alternative for all phenotypes of craniosynostosis.
此前，作者开发了一种用于治疗颅缝早闭的新型牵张成骨方法，即多向颅骨牵张成骨术（MCDO）。本研究的目的是回顾作者使用MCDO对颅缝早闭患者进行前颅重塑的经验。
2003年至2017年，45例颅缝早闭患者接受了MCDO进行前颅重塑。患者年龄为8至72个月（平均：23.9个月，中位数：13个月）。受累缝线包括14例双侧冠状缝、4例单侧冠状缝、14例矢状缝、2例额缝以及10例多条缝线。
40例患者的颅骨形状得到改善。1例患者术中大量出血，迫使我们在完成计划的截骨术前结束手术。3例患者在激活期出现短暂脑脊液漏，但经保守治疗后恢复。平均输血量为25.5 mL/kg。激活期为7至17天（平均10.6天），巩固期为16至67天（平均32.4天）。7例患者出现牵引针松动，导致2例矫正不足；19例患者出现锚定针松动，导致7例患者装置拆除加速。
多向颅骨牵张成骨术是有效的，并且相较于传统手术有多个优点。因此，作者得出结论，MCDO将是所有颅缝早闭表型的一种有用替代方法。
