Surgical management of sagittal synostosis: A comparative analysis of strip craniectomy and calvarial vault remodeling
Surgical management of sagittal synostosis: A comparative analysis of strip craniectomy and calvarial vault remodeling
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DOI：
10.1159/000121241
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发表时间：
1997-09-01
影响因子：
0.7
通讯作者：
Levy, ML
中科院分区：
文献类型：
--
作者：
Maugans, TA;McComb, JG;Levy, ML
虽然矢状骨缝的手术治疗已成为规范，但手术方式的选择仍有争议。这项回顾性分析，在洛杉矶儿童医院的10年期间（1986-1995），比较了更保守的带状颅骨切除术（SC）程序与更广泛的枕骨复位-双顶扩大颅骨穹隆重塑（CVR）技术用于矢状骨缝的管理。72例患者（61%）进行了SC，46例患者（39%）进行了CVR。接受CVR的患者年龄较大（平均5.3个月vs. 3.0个月，p < 0.01），手术时间更长（平均126分钟vs. 72分钟，p < 0.01），术中失血量更大（平均243 vs. 54 cm（3），p < 0.01），术中输血频率增加（100 vs. 38%，p < 0.01;平均体积357 vs. 51 cm（3），p < 0.01）。两组均未发生明显的术中并发症。总住院时间相似（平均4.4 vs. 3.8天，p = 0.02）。两组均未发生神经系统、血液学或输血相关并发症或死亡。CVR组的美容效果明显更好，79%的患者被评为优秀，而SC组为41%（p < 0.01）。59%的SC患者在末次随访时表现出骨缺损。2例SC患者因外观结局差需要再次手术; 2例病例均成功采用CVR。这些结果表明，CVR在对继发于矢状骨缝连的颅骨畸形提供即时和持久的矫正方面上级SC。手术时的最佳年龄是
Although surgical treatment of sagittal synostosis has become normative, the procedure of choice is still debated. This retrospective analysis, during a 10-year period (1986-1995) at Children's Hospital Los Angeles, compares the more conservative strip craniectomy (SC) procedure with a more extensive occipital reduction-biparietal widening calvarial vault remodeling (CVR) technique for the management of sagittal synostosis. SC was performed in 72 patients (61%) and CVR in 46 (39%). Patients undergoing CVR were older (mean 5.3 vs. 3.0 months, p < 0.01), the procedure time longer(mean 126 min vs. 72 min, p < 0.01), intraoperative blood loss greater (mean 243 vs. 54 cm(3), p < 0.01), and the frequency of intraoperative blood transfusion increased (100 vs. 38%, p < 0.01; mean volume 357 vs. 51 cm(3), p < 0.01) compared to patients undergoing SC. No significant intraoperative complications occurred in either group. The total time of hospitalization was similar (mean 4.4 vs. 3.8 days, p = 0.02). No neurological, hematological, or transfusion-related complications or deaths were encountered in either group. Cosmetic outcomes were significantly better in the CVR group with 79% rated as excellent compared to 41% in the SC group (p < 0.01). Fifty-nine percent of the SC patients manifested bony defects at last follow-up visit. Two SC patients required reoperation for poor cosmetic outcomes; CVR was successfully employed in both cases. These findings demonstrate that CVR is superior to SC in providing immediate and lasting correction of calvarial deformities secondary to sagittal synostosis. The optimal age at time of surgery is