Total Cranial Vault Remodeling for Isolated Sagittal Synostosis: Part I. Postoperative Cranial Suture Patency
Total Cranial Vault Remodeling for Isolated Sagittal Synostosis: Part I. Postoperative Cranial Suture Patency
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孤立性矢状骨融合的全颅穹重塑：第一部分：术后颅缝通畅
DOI：
10.1097/prs.0b013e31829f4b3d
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发表时间：
2013
影响因子：
3.6
通讯作者：
D. Chong
中科院分区：
文献类型：
--
作者：
M. Seruya;Shubin Tan;A. Wray;A. Penington;A. Greensmith;A. Holmes;D. Chong
背景：全穹隆重建术解决了肩头畸形的所有表型问题。然而，开放式颅缝重塑的临床意义尚不清楚。本研究的目的是评估孤立性矢状面融合全穹隆重建术后未受影响缝合的通畅性。方法：作者回顾了2004-2008年间因孤立性矢状面融合而行全穹隆重建术的患者的常规术后CT扫描。单一评价者对缝合通畅度的评分如下：0=闭合，1=部分开放，2=开放。单个缝合线评分为总缝合口通畅度评分。根据术后时间和颅面外科医生对CT扫描进行分层。结果：42例患者符合纳入标准。右冠状缝合、左冠状缝合、右椎板状缝合和左椎板状缝合的单条缝合率分别为42.6%、38.3%、74.5%和74.5%。椎板缝合的闭合率显著高于冠状缝合(ORClosure4.3；95%CI，2.3~8.0；P<；0.001)；椎板开放程度随时间显著改变(2=9.9，P=0.04)。在颅面外科医生中，冠状位和椎板位的通畅度是相同的。缝合通畅度总分与术后时间、手术年龄、术前头影指数、颅面外科医生无明显相关性。结论：孤立性矢状面融合的全穹隆重建可导致高度的继发性颅缝融合。椎管状缝合特别容易闭合，随着时间的推移，其通畅性会逐渐降低。目前，手术后相邻缝线的放射学融合与头部形状的任何差异没有关系。临床问题/证据水平：治疗性，IV。
Background: Total vault reconstruction addresses all phenotypic aspects of scaphocephaly. The clinical implications of remodeling across open cranial sutures, however, remain unclear. The purpose of this study was to assess patency of unaffected sutures following total vault remodeling for isolated sagittal synostosis. Methods: The authors reviewed routine postoperative computed tomographic scans of patients who underwent total vault remodeling for isolated sagittal synostosis between 2004 and 2008. Sutural patency was scored by a single reviewer as follows: 0 = closed, 1 = partial, and 2 = open. Individual suture scores were tallied for a total sutural patency score. Computed tomographic scans were stratified by postoperative time and craniofacial surgeon. Results: Forty-two patients met the inclusion criteria. Individual sutural closure rates were 42.6, 38.3, 74.5, and 74.5 percent for right coronal, left coronal, right lambdoidal, and left lambdoidal sutures, respectively. Lambdoidal sutures had a significantly higher rate of closure than coronal sutures (ORClosure, 4.3; 95 percent CI, 2.3 to 8.0; p < 0.001); lambdoidal patency significantly changed over time (&khgr;2 = 9.9, p = 0.04). Across craniofacial surgeons, coronal and lambdoidal patency were equivalent. The total sutural patency score did not significantly correlate with postoperative time, surgical age, preoperative cephalic index, or craniofacial surgeon. Conclusions: Total vault remodeling for isolated sagittal synostosis results in a high degree of secondary craniosynostosis. Lambdoidal sutures are especially prone to closure, with their patency diminishing over time. At this time, radiographic fusion of adjacent sutures following surgery has not been related to any difference in head shape. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.