儿童及青少年先天性头颅畸形颅骨重塑和牵张成骨后骨吸收的定量分析

目的定量分析儿童及青少年先天性头颅畸形患者经颅骨重塑术后骨吸收的情况。方法选取2014年3月至2018年12月在上海交通大学医学院附属第九人民医院整复外科进行颅骨重塑手术治疗的先天性头颅畸形(Crouzon综合征)患儿14例,平均年龄7.7岁,给予改良monobloc截骨牵引成骨和颅骨重塑术。调取患儿术后1周(t1)及术后1年(t2)的头颅CT扫描数据,以Dicom 3.0格式保存后,输入Mimics 18.0软件进行颅骨CT三维重建,在三维重建的颅骨上采用ROI(region of interest)曲线进行定量研究。于重建的颅骨上选取术区的自体骨移植部分,标记为目的选区,读取该区域骨体积,Vt1作为成骨牵引前骨体积,Vt2作为成骨牵引后骨体积,以(Vt1-Vt2)/Vt1×100%作为骨吸收率。采用配对Student’s-t检验对患儿术后1周和术后1年的骨体积进行比较。结果在14例患者中,有11例患者发生了骨吸收,术后1年的骨吸收率为3.482%。术后1年与术后1周骨组织体积比较,差异无统计学意义(t=0.851,P=0.410)。结论儿童及青少年先天性头颅畸形患儿经颅骨重塑和牵引成骨术后1年时出现骨吸收,但骨吸收程度可以接受。因此,对1岁以上的儿童及青少年先天性头颅畸形患儿进行颅骨重塑和牵引成骨的手术治疗方案是可行的。

Quantitative assessment for bone resorption following cranial remodeling in children and adolescent congenital cranial deformity cases

Objective To quantitatively assess the degree of bone resorption following cranial bone remodeling for children and adolescent congenital cranial deformity cases in Crouzon syndrome.Methods A total of 14 congenital cranial deformity patients(mean age 7.7 years)who underwent cranial bone remodeling between Mar.2014 and Dec.2018 were selected from Shanghai Ninth People’s Hospital,and retrospectively reviewed.They were treated with modified monobloc osteotomy and distraction osteogenesis.Craniectomy and cranial bone remodeling were performed,and the follow-up period was one week(t1)and one year(t2).The patients were scanned by spiral CT at the two following time points.Then data were imported into Mimics to acquire the three-dimensional model of skull.Bone volume was measured with Mimics Research 18.0 after three-dimensional CT reconstruction.The resorption rate was calculated as(Vt1-Vt2)/Vt1×100%(Vt1 represented bone volume before distraction osteogenesis,Vt2 represented bone volume after distraction osteogenesis),followed by statistical analysis.Results Among the 14 patients,bone resorption occurred in 11 patients and the resorption rate after 1 year was 3.482%.There was no significant difference between bone volumes at 1 week and 1 year after surgery(t=0.851,P=0.410).Conclusions Bone resorption following cranial bone remodeling for children and adolescents with congenital cranial deformity did exist,however,it was acceptable.Therefore,the surgical treatment of cranial remodeling and distraction osteogenesis is advisable for children and youth with congenital cranial deformities over 1 year old.