目的:本研究的目的是研究单侧和双侧冠状颅前突(FOA)手术后颅骨生长的纵向变化。
方法:这项回顾性研究分析了术前(T0)头围(HC)和CT数据,术后即刻(T1),40例患者(23例女性,17名男性),在1987年至2018年之间使用开放方法或牵引成骨(DO)进行了FOA。平均随访期为90.62个月。HC的z分数,基于CT的颅内容积,前后径(APD),双顶直径(BPD),和颅骨高度(CH)使用性别和年龄特异性标准进行计算。进行Logistic回归分析。
结果:虽然HC的z分数,颅内容积,BPD保持在正常范围内,APD的z评分在-2和-1之间波动,CH的z评分>2,表明从T0到T2与常模相比显著升高.手术年龄显著影响HC的z评分,BPD,和CH在T2(所有p<0.05)。手术时机的延迟与从T1到T2的BPD和CHz评分增加相关(分别为p=0.007和0.019)。FOA的DO导致T2时HCz评分升高,从T0到T1APD增加,然后从T1到T2APD复发。
结论:这些研究结果表明,延迟手术时机可能支持更好的颅骨生长,如长期随访中HC增加所示。然而,延迟的时机也与异常升高的CH恶化有关。尽管立即APD扩张和长期HC随着DO增加,潜在的复发值得谨慎。虽然建议故意过度校正APD,仔细考虑手术时机和计划至关重要。
OBJECTIVE: The objective of this study was to investigate the longitudinal changes in cranial growth following fronto-orbital advancement (FOA) surgery in patients with unilateral and bilateral coronal craniosynostosis.
METHODS: This retrospective review analyzed head circumference (HC) and CT data during preoperative (T0), immediate postoperative (T1), and final follow-up (T2) visits in 40 patients (23 female, 17 male) who underwent FOA using either the open approach or distraction osteogenesis (DO) between 1987 and 2018. The mean follow-up period was 90.62 months. The z-scores of HC, CT-based intracranial volume, anteroposterior diameter (APD), biparietal diameter (BPD), and cranial height (CH) were calculated using sex- and age-specific standards. Logistic regression analysis was performed.
RESULTS: While the z-scores of HC, intracranial volume, and BPD remained within the normal range, the z-scores of APD fluctuated between -2 and -1, and the z-scores of CH were > 2, indicating a substantial elevation compared with norms from T0 to T2. Age at surgery significantly influenced the z-scores of HC, BPD, and CH at T2 (all p < 0.05). Delayed surgical timing was correlated with increased BPD and CH z-scores from T1 to T2 (p = 0.007 and 0.019, respectively). The DO for FOA resulted in elevated HC z-scores at T2 and increased APD from T0 to T1, followed by a significant APD relapse from T1 to T2.
CONCLUSIONS: These findings suggest that delayed surgical timing may support better cranial growth, as indicated by increased HC at long-term follow-up. However, delayed timing is also associated with worsening abnormally elevated CH. Despite the immediate APD expansion and long-term HC increase with DO, potential relapse warrants caution. While intentional overcorrection of APD is recommended, careful consideration of surgical timing and planning is essential.