全颅骨切开成形矫正早期矢状缝早闭头颅畸形

目的：探讨矢状缝早闭舟状头畸形的早期手术治疗方法。方法：患儿采取改良的俯卧位,通过头皮冠状切口显露从眉间至枕骨大孔后唇的整个颅盖,切开颅骨分离双侧额骨和双侧顶-枕部骨块。对额骨和枕骨进行放射状切开、塑形纠正前后部隆突畸形;切除部分额、顶骨块缩短头颅前后径;在颞、顶骨下部采用“木桶板”样截骨以及放射状切开、塑形两侧顶骨纠正头颅狭窄畸形。结果：手术后4例舟状头畸形明显改善,外形良好,无严重并发症。术后随访3～10月,头颅外形维持良好,畸形无复发。结论：包括双侧额、顶、枕、颞全颅骨切开重新塑形的手术方法能够有效地矫正婴幼儿矢状缝早闭舟状头畸形。     

π形截骨术联合矫形头盔治疗婴儿矢状缝早闭

目的探讨π形截骨术联合矫形头盔治疗婴儿矢状缝早闭的临床效果。方法回顾性分析2020年5月至2021年3月首都医科大学附属北京儿童医院神经外科收治的矢状缝早闭患儿的临床资料。首先采用π形截骨进行治疗, 自冠状缝后约1.0 cm处横行截取宽约1.5 cm骨条, 两端至左右颞顶缝处, 且横跨矢状窦上方;自闭合的矢状缝旁开1.5 cm处平行于矢状缝及人字缝截取弧形骨条至颞顶缝处, 骨条平行于矢状缝处宽约2.0 cm, 平行于人字缝处宽约1.0 cm左右, 两侧对称性截骨, 截取的骨条类似π形。术后1～2周开始佩戴矫形头盔, 每天20～22 h, 矫正6～10个月。术后定期随访, 观察头颅形态, 测量头颅横径和前后径, 计算头颅指数(CI)及颅腔容积, CI为头颅横径与前后径的比值, CI<0.75为效果不满意, CI在0.75～0.90为效果满意。结果共纳入单纯矢状缝早闭患儿4例, 均为男性, 5～11个月龄, 术前患儿CI为0.69～0.73, 颅腔容积576.7～853.2 ml。所有患儿手术过程安全, 术中用时2.13～2.28 h, 出血量30～100 ml。术后住院时间为7～1...     

颅盖成形术治疗先天性颅缝早闭症

目的探讨治疗先天性颅缝早闭症的多种颅盖手术方法。方法采用下述方法治疗37例先天性颅缝早闭症：①眶额前移额骨瓣交叉旋转顶骨支撑术治疗短头、尖头及塔头畸形;采用梅花形颅骨瓣治疗矢状缝早闭。②额眶成形术治疗三角头。③双侧额骨瓣旋转,额眶带前移、患侧额骨瓣前倾术治疗单侧冠状缝早闭引起的前斜头畸形。④双侧顶枕骨瓣旋转交错,梅花形骨瓣成形术治疗单侧人字缝早闭引起的后斜头畸形;⑤额面前移术治疗双侧冠状缝早闭及颅底缝早闭形成的短头畸形,及合并Apert或Crouzon综合征的颅面畸形。结果37例先天性颅缝早闭症均痊愈出院,术后随访2～3年无明显并发症,头颅外形均得到了改善。结论在治疗先天性颅缝早闭症时,采用大骨瓣的颅盖成形术仍不失为治疗颅面畸形的好方法。     

先天性颅缝早闭的颅骨成形—附6例报道

目的 更好的对先天性颅缝早闭的颅骨进行颅骨成形。方法 用多种颅骨瓣旋转，调换及结合梅花瓣骨成形重建颅骨外形。结果 6例患儿均获成功，外形满意，结论 颅骨成形方法采用梅花瓣式的塑形法，可以在术中任意塑造形状，颅缝早闭症一定要扩大颅底才能彻底改变颅骨外形，减少以后中面部发育不良，采用钛板加钛条固定颅度和骨瓣，即坚强又牢固。]     

先天性颅缝早闭的颅骨成形——附6例报道

目的　更好的对先天性颅缝早闭的颅骨进行颅骨成形。方法　用多种颅骨瓣旋转、调换及结合梅花瓣骨成形重建颅骨外形。结果　 6例患儿均获成功 ,外形满意。结论　颅骨成形方法采用梅花瓣式的塑形法 ,可以在术中任意塑造形状。颅缝早闭症一定要扩大颅底才能彻底改变颅骨外形 ,减少以后中面部发育不良。采用钛板加钛条固定颅底和骨瓣 ,即坚强又牢固。     

先天性颅缝早闭的颅骨成形——附6例报道

目的更好的对先天性颅缝早闭的颅骨进行颅骨成形.方法用多种颅骨瓣旋转、调换及结合梅花瓣骨成形重建颅骨外形.结果 6例患儿均获成功,外形满意.结论颅骨成形方法采用梅花瓣式的塑形法,可以在术中任意塑造形状.颅缝早闭症一定要扩大颅底才能彻底改变颅骨外形,减少以后中面部发育不良.采用钛板加钛条固定颅底和骨瓣,即坚强又牢固.     

兔颅骨双侧冠状缝早闭后颅面骨的生长变化

为从骨生长量和生长方向两个方面探讨兔双侧冠状缝早闭后对颅骨骨生长发育的影响，用牙科釉质和剂固定２周龄幼兔双侧冠状缝，于冠状缝，鼻额缝和人字缝前后置入金属标记物，观察双侧冠状缝早闭后各骨缝及颅面长度，颅穹窿高度，长度和鼻骨长度变化情况，结果表明兔颅骨缝扩张性生长高峰期在２～８周龄，双侧冠状缝固定后，骨缝生长停止，鼻额缝补偿生长加快，４周解除固定带后，冠状缝在８周前出现补偿性生长高峰期，８周解除固定带     

骺板部分早闭的修复

目的探讨骺板再开放、骺软骨植入治疗儿童骺板部分早闭的手术及评价其疗效。方法对１０例骺板部分早闭造成的肘、膝关节内、外翻畸形,行单纯髁上楔形截骨６例,在截骨同时采取骺板再开放、骺软骨植入４例。结果１０例患儿均获得随访,随访时间为６个月～５年。单纯截骨者,术后畸形复发１例,肢体不等长２例。在截骨同时行骺板再开放、骺软骨植入者内、外髁高度相等,肢体等长,无复发。结论采用骺板再开放、骺软骨植入的方法,可以有效地预防畸形复发,恢复肢体纵向生长能力。     

大范围骨瓣切开整形治疗颅骨双侧冠状缝早闭一例

90年代开始 ,Ｐｙｏ和Ｐｅｒｓｉｎｇ[1 ] 运用眶、额、顶、枕大范围颅面骨整形治疗双侧冠状缝早闭 ,取得良好效果。我院于 2 0 0 0年 10月采用上述方法 ,成功地为一双侧冠状缝早闭幼儿手术。1　临床资料患儿 ,男 ,10个月 ,双侧冠状缝早闭伴肛门狭窄 ,尿道下裂Ⅰ型。平时患儿急躁 ,易哭闹。头颅外观为短头畸形。前囟已闭 ,双侧冠状缝骨化成嵴 ;颅腔前后径短 ,横径代偿性增大 ,两侧颞骨突出 ;额眶带后缩 ,眼球突出 ;枕骨扁平 ,颅顶骨中心前移 ,前额骨上半部异常突出。头颅三维ＣＴ显示 :双侧冠状缝闭合 ,前颅窝短小 ,前额发育不良。手术方法…     

可吸收螺钉联合腕关节成形术治疗舟状骨骨折

目的 评价可吸收螺钉联合腕关节成形术治疗舟状骨骨折的临床效果.方法 采用可吸收螺钉联合腕关节成形术治疗舟状骨骨折32例.按Herbert分型:B4型3例,B1型5例,B3型6例,B2型18例.结果 平均随访18个月(10～26个月),1例失访.疗效按MMWSS评分:优9例,良14例,一般5例,差3例,优良率达74.2%,1例骨折不愈合.结论 可吸收螺钉联合腕关节成形术可作为治疗腕舟状骨骨折的一种可靠方法 ,又可以避免二次手术.     

Sagittal suture craniosynostosis or craniosynostoses? The heterogeneity of the most common premature fusion of the cranial sutures

BackgroundScaphocephaly is usually defined as the deformation of the skull resulting from the premature fusion of the sagittal suture. It is the most common type of craniosynostosis, and can be easily recognized on simple clinical examination. Its pathophysiology is easy to understand and to confirm on neuroradiological examination. In contrast, surgical indications are still somewhat controversial, the dispute mainly concerning therapeutic versus esthetic objectives. In recent years, however, several studies have challenged these basic and relatively simplistic interpretations of the pathophysiology of the condition.Materials and methodsTo assess the heterogeneity of scaphocephaly, we reviewed cases of scaphocephaly operated on at the Hôpital Femme–Mère-Enfant, Lyon University Hospital, France during a 10-year period (2008–2017) and performed a review of the literature on scaphocephaly and sagittal suture closure.ResultsDuring the 10-year period, 401 children were operated on for a scaphocephaly at the Hôpital Femme Mère Enfant, Lyon University Hospital. Mean age at surgery was 1.14 years, for a median 0.7 years (range, 4 months to 8. 5 years). Several subtypes could be distinguished according to morphology, intracranial findings on imaging, patient age, and etiology associated to the sagittal synostosis. Two main surgical techniques were used to correct the malformation, depending on patient age, type of deformation and the surgeon's preference: cranial vault remodeling with occipital pole widening, with the patient in a prone position, and parietal enlargement with or without forehead remodeling, in dorsal decubitus.ConclusionsThe complexity and heterogeneous nature of sagittal synostoses depend on different pathogenic mechanisms leading to and interfering with the skull abnormalities: abnormalities of CSF dynamics, possibly associated with systemic alterations, accounting for the varied postoperative morphological and functional course, in terms of cognitive impairment and late complications (notably intra-cranial pressure elevation). However, the real impact of such heterogeneous clinical presentations on surgical indications and surgical results remains to be elucidated.     

Midline craniectomy for sagittal suture synostosis: comparative efficacy of two barriers to calvarial reclosure

This report quantitatively compares long-term head remolding achieved by two methods for retarding bone reunion after midline craniectomy for sagittal suture synostosis. In one group of six children the adjacent bone edges were overlayed with 1.0-cm-wide U-channel silicone strips, and in the other group, composed of seven patients, a considerably larger extent of the adjacent cranium was covered with silicone sheets. Mean percent change in the cephalic indices of the former group 18 months postoperatively was 9.1% +/- S.D. = 6.7, and of the latter group 23.7% +/- S.D. = 6.0 (p congruent to 0.01). These results indicate that the use of large silicone sheets lead to a significantly greater normalization of cranial proportions.     

颈椎间盘自发性融合1例

正患者,男,81岁,颈肩部不适伴双手发胀2个月,行走时下肢发僵伴足底踩棉花感1个月就诊。查体:蹒跚步态,项部肌肉发紧,双侧C_(5~7)神经根支配区痛觉减退,双侧肱二头肌、肱三头肌肌腱反射减弱,双上肢运动缓慢,左手握拳时各指不能触及掌心。双侧Hoffman征可疑,腹壁反射消失,双膝腱反射,双侧Babinski征+。初步诊断为混合型颈椎病(脊髓型+神经根型)。颈椎6位片显示颈椎退变,多个     

额蝶缝和鳞状缝早闭致斜头畸形五例

目的 探讨额蝶缝和鳞状缝早闭引起的斜头畸形的诊断和治疗方法.方法 ①额蝶缝早闭:若为6个月以下患儿,可戴矫形帽矫正3个月,如无效再行手术治疗,其方法与一般斜头畸形的手术方法相同,但患侧额眶桥是水平前移.②鳞状缝早闭:采用戴矫形帽法,但要将帽的受力点设在健侧的顶和额部,1个月调整1次,共佩戴6个月.结果 2005至2012年共收治5例,经三维CT诊断3例为额蝶缝早闭,均接受了手术治疗,外形满意;2例为鳞状缝早闭,经给予矫形帽治疗,头型基本获得矫正.结论 额蝶缝和鳞状缝早闭是一种较少见的引起斜头畸形的原因,早期可戴矫形帽治疗,但额蝶缝早闭再手术的可能性较大,鳞状缝早闭大多数可以通过戴矫形帽的治疗痊愈.     

腰椎间盘突出矢状位重建的CT表现

目的：研究腰椎是盘突出在矢状位上的ＣＴ表现。方法：对５０例５４个突出椎间 完成横断位扫描后进行矢状位图像重建。结果;椎间盘突出在矢状位上表现为突入椎管的软组织密度阴影。在所有病例中突出椎间盘的纵径长度都大于椎间隙高是盘突出的形态可分为：（１）铆钉形（４０个）;（２）水滴状（６个）;（３）游离型（８个）。结论：矢状位重建对于椎间盘突出有较高的诊断价值,可提供平片和横断位不易得到的解剖学信息。结合横纵