Abstract：
OBJECTIVE: To evaluate the efficacy of calvarial graft (CG) in craniovertebral fusion procedures in children at a single single center.
METHODS: Paediatric patients in whom CG had been used as the sole construct, or to augment a semi-rigid construct were identified from a prospective operative database. Age, underlying diagnosis and clinical presentation were obtained from review of the electronic patient record. The primary outcome was bony fusion confirmed on CT. Additional outcome measures were donor site morbidity and need for further surgery.
RESULTS: From 82 paediatric CVJ procedures, CG was used in 15 patients with a mean age of 4.1 (± 3.52) years. Aetiology comprised skeletal dysplasia (n = 12), congenital anomaly of segmentation (n = 1) and cervical trauma (n = 2). Myelopathy was the most common clinical finding (9/15), followed by cervical pain (3/15). The indications for surgery comprised atlanto-axial subluxation (8/15), basilar invagination with compression (2/15), and cervicomedullary compression without instability but deemed at risk of instability following decompression (4/15). CG was used in three scenarios: (i) CG + wire only (n = 10); (ii) CG + semirigid instrumentation (n = 3); (iii) CG to augment rigid instrumented fixation (n = 2). In 13 patients a Halo-body Jacket was used peri-operatively. At a mean time of 4.4 months following surgery, 80% of cases had radiological evidence of fusion.
CONCLUSIONS: Full thickness calvarial bone graft is readily available, has good structural integrity and is associated with minimal donor site morbidity. CG should be considered for use as a sole construct, or to augment semi-rigid constructs when instrumented fixation is precluded.
METHODS: Paediatric patients in whom CG had been used as the sole construct, or to augment a semi-rigid construct were identified from a prospective operative database. Age, underlying diagnosis and clinical presentation were obtained from review of the electronic patient record. The primary outcome was bony fusion confirmed on CT. Additional outcome measures were donor site morbidity and need for further surgery.
RESULTS: From 82 paediatric CVJ procedures, CG was used in 15 patients with a mean age of 4.1 (± 3.52) years. Aetiology comprised skeletal dysplasia (n = 12), congenital anomaly of segmentation (n = 1) and cervical trauma (n = 2). Myelopathy was the most common clinical finding (9/15), followed by cervical pain (3/15). The indications for surgery comprised atlanto-axial subluxation (8/15), basilar invagination with compression (2/15), and cervicomedullary compression without instability but deemed at risk of instability following decompression (4/15). CG was used in three scenarios: (i) CG + wire only (n = 10); (ii) CG + semirigid instrumentation (n = 3); (iii) CG to augment rigid instrumented fixation (n = 2). In 13 patients a Halo-body Jacket was used peri-operatively. At a mean time of 4.4 months following surgery, 80% of cases had radiological evidence of fusion.
CONCLUSIONS: Full thickness calvarial bone graft is readily available, has good structural integrity and is associated with minimal donor site morbidity. CG should be considered for use as a sole construct, or to augment semi-rigid constructs when instrumented fixation is precluded.
摘要：
目的：评估单中心儿童颅骨融合术中颅骨移植物（CG）的疗效。
方法：使用CG作为唯一结构的儿科患者，或从前瞻性手术数据库中识别出半刚性结构。年龄,从电子病历的审查中获得了潜在诊断和临床表现.主要结果是CT证实的骨融合。其他结果指标是供体部位的发病率和需要进一步手术。
结果：来自82例儿科CVJ手术，15例患者使用CG，平均年龄为4.1（±3.52）岁。病因包括骨骼发育不良(n=12)，先天性分割异常（n=1）和颈椎创伤（n=2）。脊髓病是最常见的临床发现（9/15），其次是颈椎疼痛（3/15）。手术指征包括寰枢关节半脱位（8/15），基底内陷与压缩（2/15），和颈髓内压迫没有不稳定，但被认为在减压后有不稳定的风险（4/15）。CG用于三种情况：（i）仅CG线（n=10）；（ii）CG半刚性器械（n=3）；（iii）CG以增强刚性器械固定（n=2）。在13例患者中，围手术期使用了Halo-body夹克。手术后平均4.4个月，80％的病例有融合的放射学证据。
结论：全厚度颅骨移植是现成的，具有良好的结构完整性，并与最小的供体部位发病率相关。CG应考虑用作唯一的结构，或在排除器械固定时增加半刚性结构。
方法：使用CG作为唯一结构的儿科患者，或从前瞻性手术数据库中识别出半刚性结构。年龄,从电子病历的审查中获得了潜在诊断和临床表现.主要结果是CT证实的骨融合。其他结果指标是供体部位的发病率和需要进一步手术。
结果：来自82例儿科CVJ手术，15例患者使用CG，平均年龄为4.1（±3.52）岁。病因包括骨骼发育不良(n=12)，先天性分割异常（n=1）和颈椎创伤（n=2）。脊髓病是最常见的临床发现（9/15），其次是颈椎疼痛（3/15）。手术指征包括寰枢关节半脱位（8/15），基底内陷与压缩（2/15），和颈髓内压迫没有不稳定，但被认为在减压后有不稳定的风险（4/15）。CG用于三种情况：（i）仅CG线（n=10）；（ii）CG半刚性器械（n=3）；（iii）CG以增强刚性器械固定（n=2）。在13例患者中，围手术期使用了Halo-body夹克。手术后平均4.4个月，80％的病例有融合的放射学证据。
结论：全厚度颅骨移植是现成的，具有良好的结构完整性，并与最小的供体部位发病率相关。CG应考虑用作唯一的结构，或在排除器械固定时增加半刚性结构。
