van Nunen D P F, Janssen L E, Stubenitsky B M, Han K S, Muradin M S M
Department of Plastic and Reconstructive Surgery (Head: M. Kon), University of Utrecht Medical Center, Heidelberglaan 100, PO Box 85500, 3508 GA Utrecht, The Netherlands.
Department of Plastic and Reconstructive Surgery (Head: M. Kon), University of Utrecht Medical Center, Heidelberglaan 100, PO Box 85500, 3508 GA Utrecht, The Netherlands.
J Craniomaxillofac Surg. 2014 Sep;42(6):959-65. doi: 10.1016/j.jcms.2014.01.017. Epub 2014 Jan 14.
Fronto-supraorbital bar advancement in the treatment for trigonocephaly is associated with extensive intraoperative blood loss and compensatory erythrocyte transfusions. Since both are related to the length of surgery, efforts have been focused on optimizing preoperative preparations. The utilization of three-dimensional skull models in surgical planning allows for familiarization with the patient's anatomy, the optimization of osteotomies, the preparation of bone grafts and the selection of fixation plates.
Stereolithographic skull models were used in the surgical planning for five patients with non-syndromic trigonocephaly treated in Wilhelmina Children's Hospital in 2012. A comparison group was composed of six patients with non-syndromic trigonocephaly treated by the same surgical team. Once all patients had received surgery, a retrospective chart review was performed to identify the volumes of perioperative blood loss and erythrocyte transfusions and the length of the procedure. Furthermore, the educational value of the models was assessed in a round table discussion with the surgical team and residents.
In the model group patients were transfused a mean 24 ml/kg (27% of Estimated Blood Volume [EBV]) compared to 16 ml/kg (18% of EBV) in the comparison group (P = 0.359) for a mean perioperative blood loss of 53 ml/kg (60% of EBV) in the model group against 40 ml/kg (41% of EBV) in the comparison group (P = 0.792). The mean length of surgery in the model groups was 256 min versus 252 min in the comparison group (P = 0.995). Evaluation of educational purposes demonstrated that the models had a role in the instruction of residents and communication to parents, but did not improve the insight of experienced surgeons.
The usage of stereolithographic skull models in the treatment of non-syndromic trigonocephaly does not reduce the mean volume of perioperative erythrocyte transfusions, the mean volume of perioperative blood loss nor the mean length of the surgical procedure. Nonetheless, the models do facilitate the education of the patient's parents as well as support the training of residents.
额眶上嵴前移术治疗三角头畸形与术中大量失血及补偿性红细胞输血有关。由于这两者均与手术时长相关，因此人们一直致力于优化术前准备。在手术规划中使用三维颅骨模型有助于熟悉患者的解剖结构、优化截骨术、准备骨移植材料以及选择固定板。
2012年在威廉明娜儿童医院，立体光刻颅骨模型被用于5例非综合征性三角头畸形患者的手术规划。一个对照组由同一手术团队治疗的6例非综合征性三角头畸形患者组成。所有患者接受手术后，进行回顾性病历审查，以确定围手术期失血量和红细胞输血量以及手术时长。此外，通过与手术团队和住院医师进行圆桌讨论，评估模型的教育价值。
模型组患者平均输血24 ml/kg（估计血容量[EBV]的27%），而对照组为16 ml/kg（EBV的18%）（P = 0.359）；模型组围手术期平均失血量为53 ml/kg（EBV的60%），对照组为40 ml/kg（EBV的41%）（P = 0.792）。模型组的平均手术时长为256分钟，对照组为252分钟（P = 0.995）。对教育目的的评估表明，模型在住院医师教学和与家长沟通方面发挥了作用，但并未提高经验丰富的外科医生的洞察力。
在非综合征性三角头畸形的治疗中使用立体光刻颅骨模型并不能减少围手术期红细胞输血量、围手术期失血量的平均值或手术的平均时长。尽管如此，这些模型确实有助于对患者家长进行教育，并支持住院医师的培训。
