One hundred consecutive endoscopic repairs of sagittal craniosynostosis: an evolution in care.
One hundred consecutive endoscopic repairs of sagittal craniosynostosis: an evolution in care.
复制标题
一百次连续内窥镜矢状颅缝早闭修复：护理的演变。
DOI：
10.3171/2017.5.peds16674
复制
发表时间：
2017
期刊：
影响因子：
--
通讯作者：
A. Woo
中科院分区：
文献类型：
--
作者：
D. Nguyen;S. Farber;G. Skolnick;Sybill Naidoo;M. Smyth;A. Kane;K. Patel;A. Woo
目的内窥镜辅助矢状面颅缝早闭修复术于2006年在圣路易斯儿童医院被采用。本研究检查了前100例病例，并回顾了我们机构患者护理方案的结果和演变。方法：作者对2006年至2014年间前100例矢状面颅缝早闭的连续内窥镜修复进行了回顾性图表审查。对住院时间、失血量、输血率、手术时间、头颅指数（CI）、并发症和颅骨重塑矫形器的相关数据进行了回顾。测量值取自术前和术后1年的3D重建CT扫描。结果患者手术时的平均年龄为3.3 ± 1.1个月。100名患者中，女性30名，男性70名。记录了以下围手术期数据。平均手术时间（± SD）为77.1 ± 22.2分钟，平均估计失血量为34.0 ± 34.8 ml，平均住院时间为1.1 ± 0.4天; 9%的患者需要输血;平均术前和术后CI值分别为69.1 ± 3.8和77.7 ± 4.2。1例病例由于存在难以通过内镜控制的大导静脉而需要转为开放技术。头盔治疗的平均持续时间为8.0 ± 2.9个月。最终从手术中排除了顶骨截骨。结论：在我们人群中观察到的CI的临床结局和改善与在其他高容量中心观察到的相似。自我们机构开始内镜辅助修复以来，患者护理方案经历了几次重大变化。我们已经能够使用我们的“窄顶”缝合技术切除更少的颅骨，而不影响患者的安全或结果。患者对头盔治疗的依从性和与矫形师的合作护理仍然是成功结局的最重要方面。
OBJECTIVE Endoscope-assisted repair of sagittal craniosynostosis was adopted at St. Louis Children's Hospital in 2006. This study examines the first 100 cases and reviews the outcomes and evolution of patient care protocols at our institution. METHODS The authors performed a retrospective chart review of the first 100 consecutive endoscopic repairs of sagittal craniosynostosis between 2006 and 2014. The data associated with length of hospital stay, blood loss, transfusion rates, operative times, cephalic indices (CIs), complications, and cranial remolding orthosis were reviewed. Measurements were taken from available preoperative and 1-year postoperative 3D reconstructed CT scans. RESULTS The patients' mean age at surgery was 3.3 ± 1.1 months. Of the 100 patients, 30 were female and 70 were male. The following perioperative data were noted. The mean operative time (± SD) was 77.1 ± 22.2 minutes, the mean estimated blood loss was 34.0 ± 34.8 ml, and the mean length of stay was 1.1 ± 0.4 days; 9% of patients required transfusions; and the mean pre- and postoperative CI values were 69.1 ± 3.8 and 77.7 ± 4.2, respectively. Conversion to open technique was required in 1 case due to presence of a large emissary vein that was difficult to control endoscopically. The mean duration of helmet therapy was 8.0 ± 2.9 months. Parietal osteotomies were eventually excluded from the procedure. CONCLUSIONS The clinical outcomes and improvements in CI seen in our population are similar to those seen at other high-volume centers. Since the inception of endoscope-assisted repair at our institution, the patient care protocol has undergone several significant changes. We have been able to remove less cranium using our "narrow-vertex" suturectomy technique without affecting patient safety or outcome. Patient compliance with helmet therapy and collaborative care with the orthotists remain the most essential aspects of a successful outcome.