Spring-assisted posterior vault expansion-a single-centre experience of 200 cases.
Spring-assisted posterior vault expansion-a single-centre experience of 200 cases.
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弹簧辅助后库扩展 - 200例单中心经验。
DOI：
10.1007/s00381-021-05330-5
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发表时间：
2021-10
期刊：
影响因子：
--
通讯作者：
Jeelani NUO
中科院分区：
文献类型：
--
作者：
Breakey RWF;van de Lande LS;Sidpra J;Knoops PM;Borghi A;O'Hara J;Ong J;James G;Hayward R;Schievano S;Dunaway DJ;Jeelani NUO
由于颅缝早闭导致颅缝过早融合的儿童可能会出现颅内压升高和（turri）短头畸形，需要手术治疗。弹簧辅助后穹窿扩张（SA-PVE）是英国伦敦大奥蒙德街儿童医院（GOSH）的首选手术技术。本研究旨在报告迄今为止GOSH的SA-PVE临床经验。进行了一项回顾性审查，包括2008年至2020年期间在GOSH进行的所有SA-PVE病例。记录人口统计学和临床数据，包括基因诊断、颅面手术史、手术适应症和评估、手术时年龄（弹簧插入和取出）、手术时间、住院时间、输血要求、额外/二次（颅）面部手术和并发症。在2008年至2020年期间，对184名患者（61%为男性）进行了200次SA-PVE。研究人群包括受综合征（65%）和非综合征疾病影响的患者。对颅内压升高的担忧是75%病例的手术驱动因素，其余病例进行了形状矫正手术。SA-PVE的中位年龄为19个月（范围，2-131）。首次SA-PVE的平均手术时间为150 min，弹簧取出的平均手术时间为87 min。中位住院时间为3晚，88例患者在弹簧插入时平均输血204.4 ml。迄今为止，156例患者（85%）的单次SA-PVE足够（在本分析时，26个弹簧仍在原位）; 16例患者接受了重复SA-PVE，而12例患者接受了刚性重做。当首次SA-PVE在1岁之前进行时，需要第二次SA-PVE的病例明显更多。26例患者发生并发症，共发生32起事件，包括1例死亡。41名患者在弹簧移除时进行了额眶重塑，22名患者需要额外的颅（上颌骨）面部手术。根据我们12年的经验，弹簧辅助后穹窿扩张术是一种安全、高效和有效的手术。那些在生命早期接受治疗的患者可能需要重复SA-PVE。建议长期随访，因为有些患者在以后的生活中需要额外的颅颌面矫正。
Children affected by premature fusion of the cranial sutures due to craniosynostosis can present with raised intracranial pressure and (turri)brachycephalic head shapes that require surgical treatment. Spring-assisted posterior vault expansion (SA-PVE) is the surgical technique of choice at Great Ormond Street Hospital for Children (GOSH), London, UK. This study aims to report the SA-PVE clinical experience of GOSH to date. A retrospective review was carried out including all SA-PVE cases performed at GOSH between 2008 and 2020. Demographic and clinical data were recorded including genetic diagnosis, craniofacial surgical history, surgical indication and assessment, age at time of surgery (spring insertion and removal), operative time, in-patient stay, blood transfusion requirements, additional/secondary (cranio)facial procedures, and complications. Between 2008 and 2020, 200 SA-PVEs were undertaken in 184 patients (61% male). The study population consisted of patients affected by syndromic (65%) and non-syndromic disorders. Concerns regarding raised intracranial pressure were the surgical driver in 75% of the cases, with the remainder operated for shape correction. Median age for SA-PVE was 19 months (range, 2–131). Average operative time for first SA-PVE was 150 min and 87 for spring removal. Median in-patient stay was 3 nights, and 88 patients received a mean of 204.4 ml of blood transfusion at time of spring insertion. A single SA-PVE sufficed in 156 patients (85%) to date (26 springs still in situ at time of this analysis); 16 patients underwent repeat SA-PVE, whilst 12 underwent rigid redo. A second SA-PVE was needed in significantly more cases when the first SA-PVE was performed before age 1 year. Complications occurred in 26 patients with a total of 32 events, including one death. Forty-one patients underwent fronto-orbital remodelling at spring removal and 22 required additional cranio(maxillo)facial procedures. Spring-assisted posterior vault expansion is a safe, efficient, and effective procedure based on our 12-year experience. Those that are treated early in life might require a repeat SA-PVE. Long-term follow-up is recommended as some would require additional craniomaxillofacial correction later in life.
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影响因子：
0.9
作者：
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