摘要目的 研究颅内外联合径路手术中,宽下位蒂的颅骨骨膜瓣对额骨窗回纳骨瓣术后骨吸收的影响.方法 试验组为2016年2月至2017年7月在上海市第九人民医院接受手术治疗的12例患者,男7例,女5例,年龄5～9岁,眶距增宽症10例,Crouzon综合征2例,于颅内外联合径路手术中制备宽下位蒂颅骨骨膜瓣回纳修复额骨骨窗.对照组为回顾性选取的2010年1月至2015年12月在同一医院同年龄段接受同类别手术的20例患者,男11例,女9例,年龄5～10岁,眶距增宽症7例,Crouzon综合征12例,Pfeiffer综合征1例,采用传统的颅骨瓣(未被骨膜瓣完全覆盖)回纳修复额骨骨窗.调取患者术后1周(t1)、术后1年(t2)的螺旋CT扫描数据,所得数据以DICOM 3.0格式保存后,输入Mimics 18.0软件行三维骨组织重建,选取回纳的骨瓣部分,读取该骨块体积,以(Vt1-Vt2)/Vt1×100％作为骨瓣吸收率,记录归档.用Excel 365对2组样本的骨瓣吸收率行F检验,如果满足方差齐性,继而行等方差t检验,以P＜0.05为差异有统计学意义.结果 试验组12例骨瓣吸收率为8.65％±2.56％,对照组20例骨瓣吸收率为26.51％±5.23％.2组数据比较差异具有统计学意义(t=-8.723,P＜0.001).2组病例术后1年随访均未见明显的新增颅骨缺损.结论 在颅内外联合径路手术中,宽下位蒂颅骨骨膜瓣可以有效地减轻术后额骨窗骨瓣的吸收.

abstractsObjective To observe the influence of lower wide pedicle frontal periosteum flap on frontal bone absorption rate after cranioplasty.Methods From February 2016 to July 2017,the lower wide pedicle frontal periosteum flap was produced in 12 patients of Shanghai Ninth People's Hospital (7 males/ 5 females,aged 5-9 years,10 hypertelorism,2 Crouzon syndrome),who accepted intro-cranio-route plastic surgery,to cover the frontal bone window.A spiral CT scans were applied one week (tl) and one year (t2) after surgery.DICOM data was imported into Mimics software to reconstruct the 3D model of skull.The bone window covered the frontal bone was selected and the bone volume was calculated.The absorption rate was calculated as (Vt1-Vt2)/Vt1 × 100％.As a control group,the CT data of 20 patients (from January 2010 to December 2015,11 males/9 females,7 hypertelorism,12 Crouzon syndrome,1 Pfeiffer syndrome) were analyzed retrospectively in the same way,and compared to the experimental group.Results The average bone absorption rate in experimental group was 8.65％ ±2.56％ (n =12),while in control group it was 26.51％±5.23％ (n=20).Significant statistical difference was observed.No further cranial defect was observed in one-year follow-up in both two groups.Conclusions The lower wide pedicle frontal periosteum flap reduces the bone absorption rate after intro-cranio-route plastic surgery.It could also help to repair the anterior cranial base defect during the surgery.This technique was recommend as a regular step in craniofacial surgeries.