Fearon J A, Munro I R, Bruce D A
Craniofacial Center, Medical Center Dallas Hospital.
Plast Reconstr Surg. 1995 Apr;95(4):634-7; discussion 638.
With the introduction of smaller plating systems, many surgeons have adopted their use for craniofacial procedures in infants and small children. We have encountered some previously undescribed problems associated with the use of plates and screws in infants and children. These problems can be classified into three general areas: 1) Plate displacement. This occurs after placement of the metal plates on the outside of the infant calvaria. With subsequent growth, these plates and screws may be found along the inner cortex of the skull with screw points embedded through dura. 2) Plate and screw isolation. In certain locations in young children, plates placed on the outer cortex of bone may later be found to be more prominent, isolated on a peninsula of bone. 3) Plate placement. We have also encountered plates that have been placed along the inner cortex of the skull during a previous operative procedure. This makes subsequent surgery extremely difficult and may increase the risk for secondary surgery. We propose that a previously described model for growth, involving areas of bony resorption and deposition, may be responsible for the observed plate displacement.
随着更小的接骨板系统的引入，许多外科医生已将其用于婴幼儿的颅面手术。我们遇到了一些与在婴幼儿中使用接骨板和螺钉相关的先前未描述的问题。这些问题可大致分为三个方面：1）接骨板移位。这发生在将金属接骨板放置在婴儿颅骨外侧之后。随着后续生长，这些接骨板和螺钉可能会在颅骨内皮质处被发现，螺钉尖端穿透硬脑膜嵌入其中。2）接骨板和螺钉孤立。在幼儿的某些部位，放置在骨外皮质上的接骨板后来可能会变得更加突出，孤立在一块骨半岛上。3）接骨板放置。我们还遇到过在先前的手术过程中沿着颅骨内皮质放置的接骨板。这使得后续手术极其困难，并可能增加二次手术的风险。我们认为，先前描述的涉及骨吸收和沉积区域的生长模型可能是观察到的接骨板移位的原因。
