数字化和三维打印导板定位技术在同期矫治颅缝早闭继发眶距增宽症中的应用

目的探讨数字化技术及三维打印导板定位技术系统应用于同期矫治先天性颅缝早闭症继发眶距增宽症中的临床效果。方法2015年6月至2019年8月中国医学科学院整形外科医院收治4例先天性单侧冠状缝早闭继发眶距增宽患儿,其中男1例,女3例,年龄3~8岁,采用额眶前移联合倒U形截骨同期矫治头颅畸形及眶距增宽症。术前通过数字化技术设计手术方案,三维打印头颅模型及手术导板,术中以数字化导板指导截骨,术后通过数字化技术评价其效果。测量患者术前、术后头颅三维数据,计算前颅不对称性指数(ACVAI)及眶内壁间距,并通过ProPlan CMF 3.0对术后头颅三维模型和术前模拟进行配准,制作颜色梯度图,判断术后颅骨瓣及眼眶位置与术前设计是否相同。结果4例均按照术前数字化设计方案顺利完成手术,术中截骨导板高度吻合,导板的放置未损伤周围组织,截骨时间缩短至1~2 h。术后无脑脊液漏、感染、颅内血肿及眼球损伤等并发症。术后随访4个月至3年,4例患儿头颅、眶外形都获得很大改善,ACVAI均降至3.5%以下(-1.5%~3.0%),术后的眶内壁间距减小至正常范围(22~28 mm)。颜色梯度图显示,术后效果与术前手术设计模拟效果高度吻合。结论数字化技术及三维打印导板定位技术系统、规范化地应用于复杂先天性颅缝早闭继发眶距增宽症的治疗中,可明显提高截骨的精准性,降低手术风险,缩短手术时间,获得更为满意的外形。

Application of digital technology and positioning technology with three-dimensional printing template in treating craniosynostosis secondary to orbital hypertelorism simultaneously

Objective To explore the clinical effect of digital technology and positioning technology with three-dimensional printing template which were applied systematically in the treatment of craniosynostosis secondary to orbital hypertelorism.Methods There were 4 cases of congenital premature closure of unilateral coronal suture secondary to orbital hypertelorism treated in the Plastic Surgery Hospital,Chinese Academy of Medical Sciences from June 2015 to August 2019,including 1 male and 3 females,aged from 3 to 8 years.The operation of fronto-orbital advancement and inverted U-shaped osteotomy were used to correct skull malformation and orbital widening simultaneously.Before the operation,surgical plan was designed by digital technology and three-dimensional cranial model and surgical template were printed.During the operation,template was used to guide osteotomy.After the operation,the outcome was evaluated by digital technology.Anterior cranial vault asymmetry index(ACVAI)and inter-orbital distance were calculated by measuring preoperative and postoperative cranial three-dimensional data.The color gradient map was made by ProPlan CMF 3.0 to determine whether the postoperative cranial flap and orbital position were the same as the preoperative design.Results The 4 patients were successfully received the operation according to the preoperative digital designed plan.The template was highly matched and it did not damage the surrounding tissues during the operation.The duration of osteotomy was shortened to 1-2 hours.There were no complications such as cerebrospinal fluid leakage,infection,intracranial hematoma and eyeball injury.Postoperative follow-up was conducted from 4 months to 3 years.The cranial and orbital appearances of the 4 patients were significantly improved,with ACVAI decreased to less than 3.5%(-1.5%-3.0%)and the postoperative inter-orbital distance was reduced to the normal range(22-28 mm).The color gradient diagram showed that the postoperative effect was highly consistent with the preoperative surgical design.Conclusions The application of digital technology and positioning technology with three-dimensional printing template systematically used in the treatment of complicated congenital craniosynostosis secondary to orbital hypertelorism can significantly improve the accuracy of osteotomy,reduce the risk of surgery,shorten the operation time,and obtain a more satisfactory appearance.