摘要:
目的 探讨牵张成骨术治疗综合征型颅缝早闭症的效果.方法 回顾性分析2014年1月至2018年9月南京医科大学附属儿童医院烧伤整形外科收治的6例综合征型颅缝早闭患儿临床资料,男5例,女1例,年龄1个月21d至6岁1个月,平均30个月,其中Crouzon综合征3例,Pfeiffer综合征1例,Vogt综合征(ACSⅡ型)1例,Clove leaf skull综合征1例.应用牵张成骨术进行治疗,每天延长2次,每次0.4mm,当头形明显改善时停止延长.6个月复查头颅三维CT,提示颅骨牵张成骨良好后取出延长器.记录并发症,测量延长距离,并比较术前和术后的头颅指数来评估治疗效果、手术安全性和可行性.结果 6例患儿手术和牵引过程顺利,未发生脑脊液漏、颅内感染等并发症,延长距离(19.1±3.3) mm,范围15.2~25.6 mm,术前头颅指数89.6±7.3,术后头颅指数74.2±3.6.术后随访3~20个月,平均14个月,后颅平坦的外观均得到较好地改善,患者对手术效果均满意.结论 牵张成骨术治疗综合征型颅缝早闭症效果肯定,并发症低.%Objective To explore the effect of distraction osteogenesis in the treatment of syndromic craniosynostosis.Methods The clinical data of 6 children with syndromic craniosynostosis from January 2014 to September 2018 were retrospectively analyzed.There were 5 males and 1 female,aged from 1 month and 21 days to 6 years and 1 month,with an average age of 30 months.There were 3 Crouzon syndrome,1 Pfeiffer syndrome,1 Vogt syndrome (ACS Ⅱ) and 1 Clove leaf skull syndrome.The distraction osteogenesis apparatus was used in this procedure.The distraction osteogenesis was prolonged twice a day,0.4 mm each time,and the prolongation was stopped when the skull shape was significantly improved.Three-dimensional CT scans of the skull were reviewed after 6 months,suggesting that distraction osteogenesis was good,then the lengthener was removed.Complications were recorded,and extended distances were measured.Cranial indices before and after operation were compared to evaluate the efficacy,safety and feasibility of the operation.Results The procedure of operation and traction was successful in all 6 children.There were no complications such as cranial spinal fluid (CSF) leakage or intracranial infection occurred.The increased distance was (19.1 ± 3.3) mm,ranging from 15.2 to 25.6 mm.The preoperative cranial index was 89.6 ± 7.3,while the postoperative cranial index was 74.2 ± 3.6.All patients were followed up from 3 to 20 months,with the average of 14 months.The posterior cranial flatness was improved,and the patients were satisfied with the surgical results.Conclusions Distraction osteogenesis is effective and reliable in treating the premature fusion of cranial suture,and it produces excellent result with low rate of CSF leak and infection.