Lessons Learned in Posterior Cranial Vault Distraction
Lessons Learned in Posterior Cranial Vault Distraction
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DOI：
10.1097/scs.0000000000000995
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发表时间：
2014-09-01
影响因子：
0.9
通讯作者：
Johnson, David
中科院分区：
文献类型：
--
作者：
Thomas, Gregory P. L.;Wall, Steven A.;Johnson, David
前言：后路牵张技术(PD)正迅速发展成为一种重要的治疗手段，用于增加重度短头畸形或斜颈畸形患者的颅内体积和纠正颅骨形态。方法：对2007-2012年间在牛津颅面外科接受后路牵张治疗的31例患者进行回顾性分析。结果：23例(74.2%)患者接受PD治疗，平均年龄为8个月。8名患者(25.8%)在中位年龄48个月时接受了帕金森病二次经颅手术。完全牵张至20 mm者28例(90.3%)。在这些患者中，除1例外，其余患者的形态均有显著改善，所有患者的颅内压升高症状和体征均在术前得到证实。61.3%的患者发生了意想不到的事件，19.4%的患者接受了一次或多次计划外手术。最常见的是伤口感染(29.0%)和组织坏死(22.6%)。脑脊液漏较少见(6.5%)，但妨碍了完全分心。9例(29.0%)患者的巩固期小于30天，无复发。在11例晚期额眶推进和重塑的患者中，伤口闭合紧密，导致裂开3例(27.3%)。结论：后路牵张是治疗严重短头畸形或斜头畸形的有效方法，但存在相关风险。我们的协议随着经验的发展而发展，支持缩短延迟期和整合阶段，并使用2个干扰设备。
Introduction: Posterior distraction (PD) is rapidly emerging as an important technique to increase the intracranial volume and correct calvarial morphology in patients with severe brachycephaly or turribrachycephaly.Methods: A retrospective review was performed of all 31 patients who underwent PD at the Oxford Craniofacial Unit between 2007 and 2012.Results: Twenty-three patients (74.2%) underwent PD as a primary procedure at a median age of 8 months. Eight patients (25.8%) had PD as a secondary transcranial procedure at a median age of 48 months. Full distraction to 20 mm was achieved in 28 patients (90.3%). Of these, all but 1 demonstrated a significant improvement in morphology, with a resolution of the symptoms and signs of raised intracranial pressure in all proven to have it preoperatively. Unanticipated events occurred in 61.3% of patients, with 19.4% undergoing one or more unplanned procedures. Wound infection (29.0%) and tissue necrosis (22.6%) were the commonest. Cerebrospinal fluid leaks were rarer (6.5%) but prevented full distraction. Nine patients (29.0%) had a consolidation period of less than 30 days without experiencing relapse. In 11 patients who had a later frontoorbital advancement and remodeling, wound closure was tight, resulting in dehiscence in 3 cases (27.3%).Conclusions: Posterior distraction is an effective procedure in the management of severe brachycephaly or turribrachycephaly but has associated risks. Our protocol has evolved with experience to favor a reduced latency period and consolidation phase and the use of 2 distractor devices.