Li Xiang, Zhu Wanchun, He Jintao, Di Fei, Wang Lei, Li Xin, Liu Wei, Li Chunde, Gong Jian
Department of Pediatric Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Pediatric Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
J Clin Neurosci. 2017 Oct;44:323-329. doi: 10.1016/j.jocn.2017.06.032. Epub 2017 Jul 3.
As a surgical method to treat children with sagittal craniosynostosis, calvarial vault reconstruction is subjected to some limitations. In traditional surgical method to treat children with sagittal craniosynostosis, surgical resection and fixation are performed all by the experience of surgical doctor, which is likely to cause individual differences, insecure fixation, configurational asymmetry, and waste of unnecessary fixtures materials. This study aims to provide surgical doctor with objective indicators via 3D simulation combined with biomechanical calculation, so as to improve the surgical efficiency.
The aim of this study is to compare preoperative strategy integrating computer-assisted 3D simulation and biomechanical calculation and traditional strategy. A retrospective method was used to compare the effect and difference between these 2 strategies. The clinical data of 18 patients with sagittal synostosis were collected and compared. Among them, 10 patients were enrolled in Group A applied with traditional treatment method, while 8 were enrolled in Group B applied with preoperative strategy integrating computer-assisted 3D simulation and biomechanical calculation. The aim of this study is to evaluate two treatment methods by investigating indexes between two groups, such as length of operation, blood loss, operation cost, and postoperative complications. Through comparing the cranial index, head circumference, and cranial vault asymmetry index of two groups before and after treatment, the surgical effects of two groups can be evaluated. Moreover, biomechanical analyses for two groups were conducted.
Regarding group B, the length of operation was (217±29.3min), blood loss was (70±11.7ml), operation cost was (34,495±8662¥); while for group A, the length of operation was (276±23.5min), blood loss was (90±15.5ml), operation cost was (25,149±4133¥). No postoperative complication was observed for group B, while there was 1 case of central nervous system infection occurred in group A. The cranial indexes of both groups were significantly improved after treatment. The head circumferences of both groups were insignificantly changed after treatment. Through comparing the cranial vault asymmetry index of two groups before and after treatment, the cranial vaults of patients of group A were not so symmetrical as Group B after treatment.
This research proposes the application of preoperative strategy integrating computer-assisted 3D technique and biomechanical analysis, which allows surgical doctors to have a clear understanding on the surgical process before operation. In particular, this new treatment method for the first time adopts biomechanical calculation to determine the setting position and setting quantity of fixtures materials, so as to realize a firm and symmetrical effect, reduce waste of unnecessary fixtures materials, increase surgical efficiency, reduce length of operation, blood loss, and occurrence of postoperative complications Computer-assisted 3D technique with biomechanical analysis is a new advanced technique for the treatment of sagittal craniosynostosis.
作为治疗矢状缝早闭患儿的一种手术方法，颅骨穹窿重建存在一些局限性。在传统治疗矢状缝早闭患儿的手术方法中，手术切除和固定均依靠外科医生的经验进行，这可能导致个体差异、固定不牢固、外形不对称以及不必要的固定材料浪费。本研究旨在通过三维模拟结合生物力学计算为外科医生提供客观指标，以提高手术效率。
本研究旨在比较术前结合计算机辅助三维模拟和生物力学计算的策略与传统策略。采用回顾性方法比较这两种策略的效果及差异。收集并比较18例矢状缝早闭患者的临床资料。其中，10例患者纳入采用传统治疗方法的A组，8例患者纳入采用术前结合计算机辅助三维模拟和生物力学计算策略的B组。本研究旨在通过调查两组之间的指标，如手术时长、失血量、手术费用和术后并发症，来评估两种治疗方法。通过比较两组治疗前后的颅骨指数、头围和颅骨穹窿不对称指数，可评估两组的手术效果。此外，对两组进行了生物力学分析。
B组手术时长为（217±29.3分钟），失血量为（70±11.7毫升），手术费用为（34495±8662元）；而A组手术时长为（276±23.5分钟），失血量为（90±15.5毫升），手术费用为（25149±4133元）。B组未观察到术后并发症，而A组发生1例中枢神经系统感染。两组治疗后的颅骨指数均显著改善。两组治疗后的头围无明显变化。通过比较两组治疗前后的颅骨穹窿不对称指数，A组患者治疗后的颅骨穹窿不如B组对称。
本研究提出了术前结合计算机辅助三维技术和生物力学分析的策略，使外科医生在手术前能够清楚了解手术过程。特别是，这种新的治疗方法首次采用生物力学计算来确定固定材料的放置位置和放置数量，以实现牢固且对称的效果，减少不必要的固定材料浪费，提高手术效率，缩短手术时长、减少失血量并降低术后并发症的发生率。计算机辅助三维技术与生物力学分析相结合是治疗矢状缝早闭的一种新的先进技术。
