非综合征型颅缝早闭症的手术治疗与并发症解析

doi:10.3969/j.issn.1674-8115.2026.05.013

摘要/Abstract

摘要：

非综合征型颅缝早闭症（non-syndromic craniosynostosis，NSC）是儿童期常见的先天性发育畸形。其特征为一条或多条颅缝过早融合，进而引发颅骨形态异常、颅内压升高，以及一系列神经发育问题。根据受累颅缝的差异，NSC可表现为舟状头、三角头、前斜头、短头及后斜头等多种异常头型。目前，手术治疗仍是针对NSC唯一有效的干预手段，旨在解除颅缝的融合状态、扩大颅腔容积并恢复颅颌部的正常形态。近年来，手术理念与技术持续发展，主要术式包括内镜辅助下早闭颅缝骨条切除术、颅骨重塑术（如Pi式手术及传统的大范围全颅盖切开松解重塑术），以及弹簧辅助颅骨重塑术。内镜辅助下早闭颅缝骨条切除术适用于确诊的月龄≤3个月的低龄患儿，该术式创伤小、恢复快，但术后颅骨塑形依赖佩戴头盔。Pi式手术和全颅盖重塑术可在术中即时实现显著的颅腔容积扩大与形态矫正，是目前应用于3月龄以上患儿最为广泛的术式。弹簧辅助颅骨重塑术则通过持续的牵张力实现颅腔的渐进性扩容，但需二次手术以取出植入装置。术式选择需综合患儿的年龄、畸形类型、颅内压水平及机构技术条件等因素，并且离不开多学科团队的评估与协作。尽管NSC手术总体安全性较高，但在长期随访过程中，术后复发与颅骨缺损仍是最为关键且具有重要临床意义的并发症，其中再骨化过程的异常被视为导致这些并发症的关键机制。未来研究应在明确术后再骨化机制的基础上，进一步整合个体化手术规划、新型生物材料应用，以及长期神经认知与生活质量结局的评估，以推动NSC的治疗模式从形态矫正向长期功能优化转变。

关键词: 非综合征型颅缝早闭症, 手术术式, 术后并发症, 颅骨缺损, 再骨化

Abstract:

Non-syndromic craniosynostosis (NSC) is a common congenital developmental malformation in childhood. It is characterized by the premature fusion of one or more cranial sutures, which in turn leads to abnormal skull morphology, increased intracranial pressure, and a series of neurodevelopmental problems. Depending on the different cranial sutures involved, NSC can present with various abnormal head shapes, such as scaphocephaly, trigonocephaly, anterior plagiocephaly, brachycephaly, and posterior plagiocephaly. Currently, surgical treatment remains the only effective intervention for NSC, aiming to release the fused cranial sutures, expand the cranial cavity volume, and restore normal cranio-maxillofacial morphology. In recent years, surgical concepts and techniques have been continuously evolving. The main surgical procedures include endoscopic-assisted strip craniectomy for prematurely closed cranial sutures, cranial vault remodeling (such as the Pi procedure and traditional extensive calvarial vault incision, release, and remodeling), and spring-assisted cranial vault remodeling. Endoscopic-assisted strip craniectomy is suitable for infants diagnosed within 3 months of age. This procedure is minimally invasive and allows rapid recovery; however, postoperative cranial remodeling depends on helmet therapy. The Pi procedure and total cranial vault remodeling can achieve immediate and significant expansion of cranial cavity volume and morphological correction during the operation, and are currently the most widely used surgical procedures for children over 3 months old. Spring-assisted cranial vault remodeling achieves gradual expansion of the cranial cavity through continuous traction forces, but a second operation is required to remove the implanted devices. The selection of surgical procedures needs to comprehensively consider factors such as the child′s age, type of deformity, intracranial pressure level, and the technical conditions of the institution, and also relies on the evaluation and collaboration of a multidisciplinary team. Although NSC surgery is generally highly safe, during long-term follow-up, postoperative recurrence and skull defects are still the most critical and clinically significant complications. Abnormalities in the reossification process are regarded as the key mechanisms leading to these complications. Future research should, on the basis of clarifying the mechanism of postoperative reossification, further integrate individualized surgical planning, the application of new biomaterials, and the evaluation of long-term neurocognitive and quality-of-life outcomes, so as to promote the transformation of NSC treatment from morphological correction to long-term functional optimization.

Key words: non-syndromic craniosynostosis (NSC), surgical procedure, postoperative complication, skull defect, reossification

中图分类号:

R726.2

陈锦泉, 王晓强. 非综合征型颅缝早闭症的手术治疗与并发症解析[J]. 上海交通大学学报（医学版）, 2026, 46(5): 665-671.

Chen Jinquan, Wang Xiaoqiang. Analysis of surgical treatment and complications of non-syndromic craniosynostosis[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026, 46(5): 665-671.

图/表 4

表1 非综合征型颅缝早闭的分型及异常头型

Tab 1 Subtypes of NSC and corresponding cranial deformities

Classification of NSC	Abnormal head shape
Sagittal synostosis	Scaphocephaly
Unicoronal synostosis	Anterior plagiocephaly
Bicoronal synostosis	Brachycephaly
Metopic synostosis	Trigonocephaly
Unilateral lambdoid synostosis	Posterior plagiocephaly
Bilateral lambdoid synostosis	Turricephaly

图1 内镜辅助下早闭颅缝骨条切除术示意图Note： A. Preoperative 3D CT reconstruction, frontal view. B. Preoperative 3D CT reconstruction, superior view. C. Postoperative 3D CT reconstruction, superior view.

Fig 1 Schematic diagram of ESC

图2 大范围全颅盖切开松解重塑术示意图Note： A. Preoperative 3D CT reconstruction, frontal view. B. Preoperative 3D CT reconstruction, superior view. C. Postoperative 3D CT reconstruction, frontal view. D. Postoperative 3D CT reconstruction, superior view.

Fig 2 Schematic diagram of extensive cranial vault craniotomy, release, and remodeling

图3 颅骨重塑术联合双侧额眶部前移术示意图Note： A. Preoperative 3D CT reconstruction, frontal view. B. Postoperative 3D CT reconstruction, frontal view.

Fig 3 Schematic diagram of cranial vault remodeling combined with bilateral fronto-orbital advancement surgery

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