From the Departments of Plastic and Oral Surgery, Ophthalmology, and Neurosurgery, Boston Children's Hospital; and the Department of Plastic and Reconstructive Surgery, Children's National Health System.
Plast Reconstr Surg. 2019 Mar;143(3):838-848. doi: 10.1097/PRS.0000000000005383.
Comparative effectiveness research is needed to optimize treatment of unilateral coronal synostosis. This study compares perioperative morbidity, ophthalmic, and aesthetic outcomes of patients with nonsyndromic unilateral coronal synostosis treated by endoscopic suturectomy or fronto-orbital advancement.
From 2004 to 2015, patients with unilateral coronal synostosis were reviewed and data recorded for operative details, reoperations, and aesthetic results using the Whitaker classification, severity of strabismus, and need for surgical correction. Categorical data were analyzed using the Fisher's exact test and continuous data were analyzed using the Wilcoxon rank sum test.
Ninety-four patients were treated with endoscopic suturectomy (n = 60) or fronto-orbital advancement (n = 34). Median age at follow-up was 3.5 years (range, 1 to 9 years) for endoscopic suturectomy and 5.0 years (range, 2 to 11 years) for fronto-orbital advancement (p = 0.06). The endoscopic suturectomy group had a lower operative time (42 minutes versus 216 minutes), length of stay (1 day versus 4 days), blood loss (25 cc versus 260 cc), and transfusion rate (0 percent versus 88 percent). Two patients treated with fronto-orbital advancement required secondary intervention for intracranial pressure. Thirty-one percent (16 of 52) of the endoscopic suturectomy group and 65 percent (19 of 29) of the fronto-orbital advancement group developed clinically significant strabismus requiring surgical repair (p = 0.002). In the endoscopic suturectomy group, 88 percent (50 of 57) were Whitaker class I and 5 percent were class II. In the fronto-orbital advancement group, 41 percent (14 of 34) were class I and 44 percent class II. Need for bony revision (two of 57 versus three of 34) and need for secondary cranial procedure (two of 57 versus two of 34) were similar following endoscopic suturectomy and fronto-orbital advancement.
For treatment of unilateral coronal synostosis, endoscopic suturectomy is associated with lower morbidity and comparable aesthetics. Patients treated with endoscopic suturectomy are half as likely to require strabismus surgery compared with those treated with fronto-orbital advancement.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
需要进行比较有效性研究，以优化单侧冠状缝早闭的治疗方法。本研究比较了内镜骨缝切除术与额眶前移术治疗非综合征性单侧冠状缝早闭的围手术期发病率、眼科和美容结果。
2004 年至 2015 年，回顾了单侧冠状缝早闭患者的资料，并记录了手术细节、再次手术和美容结果（采用 Whitaker 分类法）、斜视严重程度和手术矫正的需要。采用 Fisher 确切检验分析分类数据，采用 Wilcoxon 秩和检验分析连续数据。
94 例患者接受了内镜骨缝切除术（n = 60）或额眶前移术（n = 34）治疗。内镜骨缝切除术组的中位随访年龄为 3.5 岁（范围 1 至 9 岁），额眶前移术组为 5.0 岁（范围 2 至 11 岁）（p = 0.06）。内镜骨缝切除术组的手术时间（42 分钟比 216 分钟）、住院时间（1 天比 4 天）、失血量（25cc 比 260cc）和输血率（0%比 88%）均较低。2 例接受额眶前移术的患者因颅内压增高需要二次干预。内镜骨缝切除术组 31%（16/52）和额眶前移术组 65%（19/29）出现需要手术修复的临床显著斜视（p = 0.002）。内镜骨缝切除术组中，88%（50/57）为 Whitaker Ⅰ级，5%为Ⅱ级。额眶前移术组中，41%（14/34）为Ⅰ级，44%为Ⅱ级。内镜骨缝切除术组和额眶前移术组的骨修复需要（2/57 比 3/34）和二次颅部手术需要（2/57 比 2/34）相似。
对于单侧冠状缝早闭的治疗，内镜骨缝切除术的发病率较低，且美容效果相当。与接受额眶前移术的患者相比，接受内镜骨缝切除术的患者发生斜视手术的可能性减半。
临床问题/证据水平：治疗，III 级。
