AIM: To compare, and to analyze the effects of fronto-orbital band anterior displacement in the operation of premature closure of coronal suture in infants.MATERIAL and METHODS: A total of 31 infants with premature closure of coronal suture were randomly divided into two groups; experimental group (n=16) and control group (n=15). In the experimental group, the skull model was reconstructed by an imaging examination and three-dimensional (3D) printing technique before the operation, and the fronto-orbital band was anteriorly displaced during the operation to guide the surgical treatment of craniosynostosis. In the control group, the skull model was reconstructed by an imaging examination and 3D printing technique before the operation, and the fronto-orbital band was not anteriorly displaced during the operation by the same operator. The surgical effects of the two groups were compared.RESULTS: During the 12-month follow up after the operation, the cephalic index of short head deformity in the experimental group was 80.7 +/- 1.1, while that in the control group was 89.3 +/- 4.5. There was a significant difference between the two groups.CONCLUSION: Fronto-orbital band anterior displacement may guide the operation of craniosynostosis and significantly improve the effectiveness of surgical treatment of children with premature closure of coronal suture, which is worth popularizing in the clinical management of cases.

AIM This study aimed to compare and analyze the effects of cranial suture reconstruction and frontal bone reconstruction in the operation of premature closure of the sagittal suture in infants. MATERIAL AND METHODS A total of 35 infants with simple premature closure of frontal suture were divided into the experimental group (n = 18) and the control group (n = 17). In the experimental group, the skull model was reconstructed by imaging examination and three-dimensional (3D) printing technique before operation, and the frontal bone reconstruction was used to guide the surgical treatment of cranial stenosis. In the control group, the skull model was reconstructed by imaging examination and 3D printing technique before operation, and the cranial suture reconstruction was performed by the same operator. The surgical effects of the two groups were compared. RESULTS During the 12-month follow-up after operation, the interfrontal angles of scaphoid malformation were 153.67 ± 12.77 and 128.67 ± 7.90 in the experimental and control groups, respectively. The difference between the two groups was statistically significant. CONCLUSION Frontal bone reconstruction surgery can guide the operation of cranial stenosis, significantly improve the surgical treatment effect of infants with frontal suture, and esthetically enhance the head type of infants. Moreover, its effect is better than that of traditional operation, which is worth given significant attention in clinical settings.

AIM:To compare and analyze the effects of cranial suture reconstruction and frontal frame retraction for surgical treatment of premature closure of the sagittal suture.MATERIAL AND METHODS:Infants with premature closure of the sagittal suture were included in this study. All infants underwent preoperative skull model reconstruction using imaging techniques and 3D printing. The infants were then allocated to either the experiment group, where the frontal frame retraction was used to guide the surgical treatment of cranial stenosis, or the control group, where traditional cranial suture reconstruction was performed. All interventions were performed by the same operator. The surgical effects of the two groups were compared.RESULTS:Overall, 28 infants were enrolled in this study, with 15 infants in the experimental group and 13 in the control group. In the one-year post-operative follow-up visit, the cephalic index of scaphoid malformation was 78.3 ± 1.4 in the experimental group and 69.0 ± 4.2 in the control group. The difference between the two groups was statistically significant.CONCLUSION:Frontal frame retraction surgery can guide the surgical procedure for cranial stenosis, significantly improve the treatment outcome in children with premature closure of the sagittal suture, and improve the form of the head aesthetically in children, and the effect is better than traditional operation; therefore, the technique is worth popularizing in the clinic.

Objective To evaluate the effectiveness of Ilizarov technique combined with soft tissue release and muscle strength balance in the treatment of spastic clubfoot in adolescents with cerebral palsy. Methods A retrospective analysis of clinical data of 29 cases (33 feet) of cerebral palsy spastic clubfoot deformity conformed to the selection criteria between June 2011 and September 2016. Among them, 17 were male (20 feet) and 12 were female (13 feet) with an age range from 13 to 28 years (mean, 17.6 years). According to Diméglio classification, 19 feet were rated as gradeⅡ and 14 feet as grade Ⅲ. All patients were treated with soft tissue release and muscle balance, while using Ilizarov technique to correct varus deformity. Began to gradually adjust the external fixator after 5-7 days of operation, until to reach satisfactory foot ankle form. Orthopedic brace was used after removal of external fixator, and the wearing time gradually reduced to completely abandon the brace. Results All 29 patients (33 feet) were followed up 12-22 months with an average of 18 months. All patients restored line plantar foot without needle infection and nerve or vessel injury. One foot had a mild relapse of deformity at 6 months after removal of external fixator, and the gait restored to normal after symptomatic treatment. The rest of 32 feet had no deformity recurrence during the follow-up. At last follow-up, International Club Foot Study Group (ICFSG) score (5.21±3.91) was significantly lower than the preoperative score (36.73±4.80), and the difference was significant ( t=47.227, P=0.000). The results were excellent in 27 feet, good in 3 feet, and fair in 3 feet, and the excellent and good rate was 90.91%. The patients were very satisfied in 27 feet and satisfied in 6 feet by self-evaluation of effectiveness. Conclusion Ilizarov technique is effective in treatment of clubfoot. And it is also a feasible method to treat spastic clubfoot in adolescents with cerebral palsy when combined with appropriate soft tissue surgery according to the patient's symptoms and signs.

STUDY DESIGN:A case report and review of the literature.OBJECTIVE:The aim of this study was to describe the successful treatment of one posterior atlantoaxial dislocation without fracture and to review the relevant literature.SUMMARY OF BACKGROUND DATA:Posterior atlantoaxial dislocation without fracture of the odontoid process is extremely rare. Management of these patients is still unknown.METHODS:A posterior atlantoaxial dislocation without fracture in a 58-year-old man with incomplete quadriplegia was treated surgically with posterior atlantoaxial pedicle screws internal fixation and fusion after closed reduction. The images, treatment, and related literature are reviewed.RESULTS:The patient had complete recovery of neurologic deficit and bony fusion of the atlantoaxial joint was identified on the follow-up computed tomography taken 3 months after posterior fixation. To our knowledge, no case of posterior atlantoaxial dislocation with neurologic deficit has been previously reported in English medical literature.CONCLUSION:We described a rare case of posterior atlantoaxial dislocation with neurologic deficit. Treatment procedure of posterior atlantoaxial dislocation was presented.LEVEL OF EVIDENCE:5.

Study Design. Prospective study. Objective. To analyze the most feasible choice of C1 lateral mass (C1LM) and C2 pedicle (C2P) screw in upper cervical surgeries for children younger than 6 years. Summary of Background Data. The C1LM and C2P screw technique is a stable cervical vertebrae internal fixation method in upper cervical surgery. Some tomographic studies have indicated the feasibility of insertion of C1LM and C2P screws in children. Their results, however, varied widely, and no consensus was achieved regarding C1LM and C2P screw choices for different ages in the pediatric population, sex, and laterality. Methods. The computed tomography images of 250 patients (age 2–6 yr) were studied. The inner diameter and length for each C1LM and C2P were measured in axial view. Height was measured in sagittal view. Screw choice was considered feasible when a sample maintained an additional 0.5 mm bone cortex at the inner diameter, length, and height at the same time. Analyses with the Student t test were performed for age, sex, and laterality. The screw choice was evaluated with a feasibility percentage. Results. Statistical differences were found between different ages, sex, and laterality for C1LM length (P < 0.001) and C2P length (P < 0.001). Screws of different sizes were recommended for each age group, sex, and laterality, with a feasibility percentage. Conclusion. The use of a 3.5-mm lateral mass and pedicle screw in 2- to 6-year-old children was feasible in the majority of cases. Age, sex, and laterality should all be considered when choosing screw sizes in pediatric upper cervical surgeries. This information can be particularly helpful for preoperative planning for C1-C2 internal fixation. Level of Evidence: 3