Posterior vault distraction osteogenesis with fixation of lambdoid sutures for the craniosynostosis in infants
10.3760/cma.j.cn114453-20200305-00112
- VernacularTitle:后颅牵张成骨术结合人字缝固定治疗婴儿颅缝早闭症
- Author:
Yi JI
1
;
Liangliang KONG
;
Jie CUI
;
Jianbing CHEN
;
Weimin SHEN
Author Information
1. 南京医科大学附属儿童医院烧伤整形外科 210008
- Keywords:
Craniosynostosis;
Osteogenesis, distraction;
Infants
- From:
Chinese Journal of Plastic Surgery
2020;36(12):1335-1340
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the treatment of craniosynostosis in small infants with posterior vault distraction osteogenesis and the reasonable treatment for lambdoid sutures during operation.Methods:Seven cases with syndromic craniosynostosis who were admitted to our department from January 2017 to August 2019 were osteotomized by piezosurgery supraoccipital protuberance osteotomy in the posterior cranium, and two 2 cm distractors were placed in the lateral cranium. In 4 of 7 cases bilateral lambdiod sutures were fixed with titanium plate, while 3 of 7 were not fixed. Distraction was started from 5 days postoperatively, once a day on each side with a rate of 0.4-0.8 mm/d on each side for 10-15 days. The distractors were removed 6 months postoperatively. The titanium plates fixation in 4 cases were also removed at the same time.Results:The patients were followed up for 6 to 14 months, with an average of 12 months. The skull cavity and posterior cranial shape were observed. The posterior vault was distracted completely with lambdoid suture fixation in 4 cases. In the other 3 cases, the posterior skull was flattened. All skull deformities were significantly improved without death, skull necrosis, intracranial infection and other serious complications. The cranial index of both groups of lambdoid suture fixed and unfixed were reduced after the operation, and the fixed group was reduced by an average of 20.5%±5.8%, higher than the unfixed group(17.5%±5.1%), but the difference between the two groups was not statistically significant( P>0.05). The occipitofrontal circumference was increased after the operation in the two groups. The fixed group was increased by (2.7±0.4)cm on average, which was significantly higher than the unfixed group(1.7±0.1) cm. And the difference was statistically significant( t=3.789, P=0.013). Conclusions:Posterior vault distraction osteogenesis is a good method to treat the syndromic craniosynostosis. But bilateral lambdoidsuture needs to be fixed in infants. Titanium plate fixation could make the posterior cranium into a whole cranial plate for posterior vault distraction osteogenesis. And the posterior vault was obviously flat without lambdoid sutures fixation. Flatted occipital contour was improved significantly and the result of the fixed group was superior to the unfixed one. Bilateral fixation of lambdoid sutures is suitable for the infants, especially for severe syndromic craniosynostosis.
