鼻根部楔形截骨治疗单侧冠状缝早闭症鼻畸形

摘要

Objective To investigate the treatment of nasal deformity in patients with unicoronal craniosynostosis.Methods In patients over 6 months old,the nasal bones were wedge-removed without fixation.The management of all patients with unicoronal craniosynostosis was distraction osteogenesis of pedicled unilateral frontal bone flap.Results Postoperative extended distance of the frontal bone was 28-41 mm (mean,35.4 mm).After extension,three-dimensional reconstruction of cranial CT was carried out,which showed that CVAI was 0.8-1.2 (mean,0.98),tending to normal.After discharge,dynamic cranial braces were put on for 1 year.Postoperatively,the children were followed up for 8-36 months (mean,28 months).The shape and nasal deformity of all children were improved compared with those before surgery.Conclusions Nasal wedge resection should be used to correct nasal deformity in children over 6 months with unicoronal craniosynostosis.%目的 探讨单侧冠状缝早闭症斜头畸形出现的鼻畸形的处理方法.方法 2015年1月至2017年1月南京医科大学附属儿童医院烧伤整形科治疗5例单侧冠状缝早闭患儿,男1例,女4例,年龄8～14个月,平均10.4个月.在矫正眶额畸形的同时,于鼻骨上做楔形切除截骨,但不做固定.单侧冠状缝早闭症以半侧额骨带蒂骨瓣进行牵张成骨治疗.结果 术后额骨延长28～41 mm,平均35.4 mm,延长结束后行头颅CT三维重建,测得颅顶不对称指数为0.8～1.2,平均0.98,趋于正常.出院后佩戴动态颅支具1年.患儿术后随访8～36个月,平均28个月,所有病例外形和鼻畸形均较术前有所改善.结论 采用鼻骨楔形切除、额骨牵张成骨术可以较好地矫正6个月以上单侧冠状缝早闭症患儿的鼻畸形.