Wagner J D, Cohen S R, Maher H, Dauser R C, Newman M H
University of Michigan Craniofacial Anomalies Program, Ann Arbor, MI, USA.
J Craniofac Surg. 1995 Jan;6(1):32-7; discussion 38-9. doi: 10.1097/00001665-199501000-00010.
We retrospectively assessed the intermediate and long-term results of craniofacial surgery in 22 consecutive patients with nonsyndromic bicoronal synostosis to determine the outcome of corrective surgery. The study population consisted of 13 males and 9 females whose ages ranged from 6 weeks to 24 months (mean, 5.6 months) at the time of initial surgery. All patients had been assigned a diagnosis of nonsyndromic bicoronal synostosis. Each patient underwent resection of both coronal sutures and frontal orbital advancement with cranial vault remodeling using a floating forehead technique. Age at initial operation was 5 months or less in 13 patients and 6 months or more in 9. Complications occurred in 5 patients (23%), and 1 patient with an associated metabolic disorder died from respiratory arrest postoperatively. Follow-up ranged from 6 to 168 months (mean, 53.2 months). Results were graded according to the need for and extent of reoperation. Residual aesthetic deformities were documented in 12 patients (55%). Three patients (14%) required calvarial recontouring or cranioplasty to achieve satisfactory forehead contour or bony continuity. Total reoperation for recurrent deformity was required at a mean age of 29.7 months in 8 patients (36%) and is pending in another (4%). Four patients (18%) required a third operation (two total reoperations and two cranioplasties) to achieve satisfactory results. Eight of 13 patients (62%) operated on at 5 months of age or younger required total reoperation compared with 1 of 9 (11%) operated at 6 months of age or older. When analyzed alone, age of operation was a statistically significant determinant of the need for reoperation (p < 0.03). However, when subjected to multivariate analysis, neither age at operation nor the presence of an associated anomaly or positive family history had a significant effect on outcome.
我们回顾性评估了22例连续性非综合征性双冠状缝早闭患者行颅面外科手术的中长期结果，以确定矫正手术的效果。研究对象包括13例男性和9例女性，初次手术时年龄在6周龄至24个月龄之间（平均5.6个月）。所有患者均被诊断为非综合征性双冠状缝早闭。每位患者均接受了双侧冠状缝切除及额眶前移，并采用浮动前额技术进行颅盖重塑。13例患者初次手术年龄在5个月及以下，9例患者在6个月及以上。5例患者（23%）出现并发症，1例合并代谢紊乱的患者术后死于呼吸骤停。随访时间为6至168个月（平均53.2个月）。结果根据再次手术的必要性和范围进行分级。12例患者（55%）记录有残余美学畸形。3例患者（14%）需要进行颅骨重新塑形或颅骨成形术以获得满意的前额轮廓或骨连续性。8例患者（36%）因复发性畸形需要再次手术，平均年龄为29.7个月，另1例患者（4%）的再次手术尚未进行。4例患者（18%）需要进行第三次手术（2例全再次手术和2例颅骨成形术）以获得满意结果。13例5个月龄及以下接受手术的患者中有8例（62%）需要全再次手术，而9例6个月龄及以上接受手术的患者中有1例（11%）需要全再次手术。单独分析时，手术年龄是再次手术必要性的统计学显著决定因素（p < 0.03）。然而，进行多变量分析时，手术年龄、合并异常情况或阳性家族史均对结果无显著影响。
