Cho Regina S, Lopez Joseph, Musavi Leila, Kachniarz Bartlomiej, Macmillan Alexandra, Badiei Beita, Bello Ricardo, Dorafshar Amir H
Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD.
Royal Devon and Exeter NHS Trust, Exeter, United Kingdom.
J Craniofac Surg. 2019 Oct;30(7):2034-2038. doi: 10.1097/SCS.0000000000005748.
The purpose of this study was to assess whether long-term outcomes were equivalent between computer-assisted design and manufacturing (CAD/CAM) -assisted cranial vault reconstruction performed by an inexperienced surgeon, with fewer years of surgical experience, and traditional reconstruction performed by senior surgeons with many decades of experience.
An Institutional Review Board-approved retrospective cohort study was performed for all patients with nonsyndromic craniosynostosis between the ages of 1 month to 18 years who received primary, open calvarial vault reconstruction at the Johns Hopkins Hospital between 1990 and 2017. The primary outcome variable was the Whitaker category (I-IV) for level of required revision at the 2-year follow-up visit. Secondary outcomes included estimated blood loss, length of stay, operative time, and postoperative complications. CAD/CAM-assisted surgery was considered noninferior if the proportion of cases requiring any revision (Whitaker II, III, or IV) was no more than 10% greater than the proportion in the traditional surgery group with multivariate logistic regression analysis. t tests and fisher exact tests were used for secondary outcomes.
A total of 335 patients were included, with 35 CAD/CAM-assisted reconstructions. CAD/CAM-assisted reconstruction was noninferior to traditional after accounting for patient demographics, type of surgery, and experience level of the plastic surgeon. The traditional group required revision more frequently at 29.0% compared to CAD/CAM at 14.3%. Secondary outcomes were not significantly different between groups, but CAD/CAM had significantly longer average operative times (5.7 hours for CAD/CAM, 4.3 hours for traditional, P < 0.01).
CAD/CAM technology may lower the learning curve and assist less experienced plastic surgeons in achieving equivalent long-term outcomes in craniofacial reconstruction.
本研究旨在评估由经验较少、手术年限较短的外科医生进行的计算机辅助设计与制造（CAD/CAM）辅助颅盖重建与由经验丰富、有数十年经验的资深外科医生进行的传统重建的长期效果是否相当。
对1990年至2017年间在约翰霍普金斯医院接受初次开放性颅骨穹窿重建的1个月至18岁非综合征性颅缝早闭患者进行了一项经机构审查委员会批准的回顾性队列研究。主要结局变量是2年随访时所需翻修水平的惠特克分类（I-IV）。次要结局包括估计失血量、住院时间、手术时间和术后并发症。如果多因素逻辑回归分析显示需要任何翻修（惠特克II、III或IV）的病例比例不超过传统手术组比例的10%以上，则CAD/CAM辅助手术被认为不劣于传统手术。次要结局采用t检验和费舍尔精确检验。
共纳入335例患者，其中35例采用CAD/CAM辅助重建。在考虑患者人口统计学、手术类型和整形外科医生经验水平后，CAD/CAM辅助重建不劣于传统重建。传统组的翻修频率为29.0%，高于CAD/CAM组的14.3%。两组的次要结局无显著差异，但CAD/CAM的平均手术时间明显更长（CAD/CAM为5.7小时，传统手术为4.3小时，P<0.01）。
CAD/CAM技术可能会降低学习曲线，并帮助经验较少的整形外科医生在颅面重建中取得相当的长期效果。
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