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目的:探讨后颅牵张成骨术结合人字缝固定治疗婴儿颅缝早闭症的临床效果。方法:2017年1月至2019年8月，南京医科大学附属儿童医院烧伤整形外科共收治7例综合征型颅缝早闭患儿，男4例，女3例，年龄3～11个月，平均6个月，4例为Apert综合征，2例为Crouzon综合征，1例为Pfeiffer综合征。用超声骨刀在后颅采用枕骨结节上截骨方法进行截骨，在双侧颅骨颞枕部安装2个2 cm的延长器，其中4例患儿行双侧人字缝钛板固定(人字缝固定组)，3例未进行人字缝固定(未固定组)。均于术后5 d开始牵张进行延长，每日每侧1次，每侧0.4～0.8 mm/d，10～15 d延长期，6个月固定期后行二次手术拆除延长器，人字缝固定组患儿同时拆除钛板。均于术前及6个月固定期后拆除延长器前，测量2组患儿额枕周长与头颅指数变化情况，2组间比较采用独立样本n t检验，以n P0.05)。人字缝固定组和未固定组手术后额枕周长均较手术前增加，固定组手术后额枕周长增加(2.7±0.4) cm，显著高于未固定组的(1.7±0.1) cm，差异有统计学意义(n t＝3.789，n P＝0.013)。n 结论:后颅牵张成骨术治疗颅缝早闭症患儿时，用钛板固定人字缝可使后颅成为一整块颅板进行后颅牵张成骨，枕部扁平畸形改善效果更加明显，后颅饱满，效果优于未固定人字缝患儿，尤其适用于严重综合征型的低龄患儿。“,”Objective:To investigate the treatment of craniosynostosis in small infants with posterior vault distraction osteogenesis and the reasonable treatment for lambdoid sutures during operation.Methods:Seven cases with syndromic craniosynostosis who were admitted to our department from January 2017 to August 2019 were osteotomized by piezosurgery supraoccipital protuberance osteotomy in the posterior cranium, and two 2 cm distractors were placed in the lateral cranium. In 4 of 7 cases bilateral lambdiod sutures were fixed with titanium plate, while 3 of 7 were not fixed. Distraction was started from 5 days postoperatively, once a day on each side with a rate of 0.4-0.8 mm/d on each side for 10-15 days. The distractors were removed 6 months postoperatively. The titanium plates fixation in 4 cases were also removed at the same time.Results:The patients were followed up for 6 to 14 months, with an average of 12 months. The skull cavity and posterior cranial shape were observed. The posterior vault was distracted completely with lambdoid suture fixation in 4 cases. In the other 3 cases, the posterior skull was flattened. All skull deformities were significantly improved without death, skull necrosis, intracranial infection and other serious complications. The cranial index of both groups of lambdoid suture fixed and unfixed were reduced after the operation, and the fixed group was reduced by an average of 20.5%±5.8%, higher than the unfixed group(17.5%±5.1%), but the difference between the two groups was not statistically significant(n P>0.05). The occipitofrontal circumference was increased after the operation in the two groups. The fixed group was increased by (2.7±0.4)cm on average, which was significantly higher than the unfixed group(1.7±0.1) cm. And the difference was statistically significant(n t=3.789, n P=0.013).n Conclusions:Posterior vault distraction osteogenesis is a good method to treat the syndromic craniosynostosis. But bilateral lambdoidsuture needs to be fixed in infants. Titanium plate fixation could make the posterior cranium into a whole cranial plate for posterior vault distraction osteogenesis. And the posterior vault was obviously flat without lambdoid sutures fixation. Flatted occipital contour was improved significantly and the result of the fixed group was superior to the unfixed one. Bilateral fixation of lambdoid sutures is suitable for the infants, especially for severe syndromic craniosynostosis.