A Clinical Retrospective Study Of Combined Use Of Absorbable Fixation System And Rigid Internal Fixation System In Congenital Craniosynostosis

ObjectiveUsing digital technology,by comparing the three-dimensional CT data of patients in short-term and long-term follow-up,the changes of brain volume were measured and compared with the normal control group.The effect of the combined use of absorbable internal fixation system and rigid internal fixation system on the long-term cranial development in the treatment of congenital craniosynostosis.To compare the skull development of patients with congenital craniosynostosis after operation for 2-week and long-term follow-up,and to compare the development rate of different regions of skull,to guide the application of absorbable internal fixation system and rigid internal fixation system in different regions of congenital craniosynostosis.MethodsFrom January 2012 to April 2021,patients with non-syndromic congenital craniosynostosis were treated in the craniofacial digital center of plastic surgery Hospital of Chinese Academy of Medical Sciences.Patients without absorbable internal fixation system and incomplete follow-up data were excluded.Finally,8 patients with congenital craniosynostosis were included,including 5 females and 3 males.The average age was 3.8 years old.There were 4 cases of left coronary suture congenital craniosynostosis,3 cases of right coronary suture congenital craniosynostosis and 1 case of all cranial suture congenital craniosynostosis.The average follow-up time was 23.25 months.Each patient was scanned by low-dose spiral CT,and the DICOM data of three-dimensional cranial CT were collected before operation,after operation 2-week and in long-term follow-up.The 3D analysis software was used to compare the development of skull bone,and the heat map of skull development deviation analysis was generated.At the same time,3D analysis software was used to compare the brain tissue volume of normal children.In the control group,the brain tissue volume of normal children was obtained by matching the age and sex of normal children in the cranial volume curve of normal children reported by Abott et al.ResultsThe results of heat map comparison of skull development deviation analysis showed that the deviation degree of bone tissue in frontal and orbital region was less than that in frontal bone and parietal region,that is,the displacement of bone tissue in frontal and orbital region was lower than that in frontal bone and parietal bone.The degree of overall deviation of the skull increased with the increase of follow-up time.The results of cranial volume comparison showed that there was significant difference between the 2-week group and the follow-up group(P<0.05).There was no significant difference between the postoperative group and the control group,and there was no significant difference between the follow-up group and the control group(P=0.78,P=0.37).It can be seen that the combined application of absorbable internal fixation system and rigid internal fixation system in the surgical treatment of congenital craniosynostosis does not affect the normal growth and development of the patient’s skull.Conclusion1.By comparing the brain volume,the combined application of absorbable internal fixation system and rigid internal fixation system in the surgical treatment of congenital craniosynostosis does not affect the development of patients’ long-term skull volume.fully retain the advantages of absorbable internal fixation system.2.By comparing the development of skull bone in different regions,in children with coronary suture congenital craniosynostosis and treated with Fronto-Orbital Osteotomy(FOA)and Floating frontal flap procedure,the supraorbital frontal bridge region is the "rigid internal fixation area,RIFA" suitable for rigid internal fixation system,and the frontal bone and parietal bone region is the "absorbable Internal fixation area,AIFA" suitable for absorbable internal fixation system.The concept of these two regions can provide a reference for the selection of different internal fixation systems in different positions of congenital craniosynostosis in the future.3.In the surgical treatment of congenital craniosynostosis,the combined application of rigid internal fixation system and absorbable internal fixation system ensures not only the stability of postoperative shape but also the development of skull in the future.