Department of Plastic and Reconstructive Surgery.
Department of Pediatric Neurosurgery, Osaka City General Hospital, Osaka, Japan.
J Craniofac Surg. 2020 Oct;31(7):e724-e730. doi: 10.1097/SCS.0000000000006700.
In craniosynostosis patients under 3 months of age, suturectomy is a valuable early treatment improving their outcomes. However, conventional suturectomy might not be in severe patients. The efficacy of our developed suturectomy using absorbable plates was examined.
Our method was indicated for craniosynostosis patients under 3 months old who had severe intracranial hypertension, scaphocephaly, plagiocephaly, or trigonocephaly between September 2011 and March 2018. All patients underwent suturectomy, and the bone edges on both sides of the cuts were covered with absorbable plates. Evaluation was conducted with 3-dimensional computed tomography and photographs, and cephalic index, distance from dorsum sellae to forehead on computed tomography were analyzed.
Twenty-one of the 25 patients were evaluated. The preoperative cranial shapes were 4 brachycephaly, 6 scaphocephaly, 5 oxycephaly, 2 clover-leaf deformity, and 4 plagiocephaly. There were 9 syndromic and 12 nonsyndromic patients. The mean age at the time of surgery was 52.3 days (7-89), and the mean follow-up period was 3.5 years (1-8).The cephalic index and cranial definition improved in 18 patients. The secondary surgery was not required in four syndromic and none of the 12 nonsyndromic patients. There were no major complications.
Placement of absorbable plates was able to prevent bone formation during the early postoperative period, and yet also promote bone formation after plate absorption. The authors believe syndromic craniosynostosis patients with severe deformities and nonsyndromic ones with scaphocephaly or plagiocephaly, successfully avoided secondary surgeries. This approach is less invasive for craniosynostosis and is expected to be highly effective.
在 3 个月以下的颅缝早闭患者中，骨缝切除术是一种有价值的早期治疗方法，可以改善患者的预后。然而，对于严重的患者，传统的骨缝切除术可能并不适用。我们开发的使用可吸收板的骨缝切除术的疗效在本文中得到了检验。
我们的方法适用于 3 个月以下、患有严重颅内高压、舟状头畸形、斜头畸形或三角头畸形的颅缝早闭患者。所有患者均接受了骨缝切除术，切口两侧的骨缘用可吸收板覆盖。通过三维 CT 和照片进行评估，并分析 CT 上蝶鞍背至额部的距离和头颅指数。
25 例患者中有 21 例得到了评估。术前头颅形状为 4 例短头畸形、6 例舟状头畸形、5 例斜头畸形、2 例三叶头畸形和 4 例斜头畸形。其中 9 例为综合征型，12 例为非综合征型。手术时的平均年龄为 52.3 天（7-89 天），平均随访时间为 3.5 年（1-8 年）。18 例患者的头颅指数和颅形得到了改善。4 例综合征型和 12 例非综合征型患者均无需进行二次手术。无重大并发症发生。
可吸收板的放置能够在术后早期阻止骨形成，同时在板吸收后促进骨形成。作者认为，严重畸形的综合征型颅缝早闭患者和舟状头畸形或斜头畸形的非综合征型患者，成功避免了二次手术。这种方法对颅缝早闭的侵袭性较小，预计效果显著。
