数字化3D仿真模型辅助精准化整复颅眶畸形的效果评价

Evaluation of digital 3D simulation model assisted in the precise reconstruction of cranio-orbital deformities

目的:探讨数字化仿真3D模型在颅眶畸形精准化整复术中的应用效果。方法:收集2013年1月—2019年1月福建医科大学附属第一医院收治的44例颅眶畸形病例:创伤性颅眶畸形43例和先天性颅眶畸形1例;将创伤性患者分为传统组和模型组。除传统组外,所有患者术前均进行头颅螺旋CT薄层扫描(层厚≤1.0 mm)。采集原始DICOM数据,利用计算机数字化软件重建头颅三维数据(STL格式),并通过快速成型技术和反求镜像工程技术制作头颅3D仿真模型。术前利用数字化软件模拟手术过程,并在模型上进行手术演练、预弯或预制植入材料,术中指导手术入路和解剖部位的确认。术后收集手术时间、颅眶对称性和满意度。采用SPSS 25.0软件包对数据进行统计学处理。结果:随访3个月~6 a,所有患者均未出现颅内血肿、颅内感染、失明、脑疝、嗅觉丧失等严重并发症;仅1例出现脑脊液鼻漏,经保守治疗后痊愈。模型组手术时间显著少于传统组(P<0.05),模型组的术后满意程度和对称性显著优于传统组(P<0.05)。结论:数字化3D仿真模型能够提供精准的诊疗信息,为精准、安全整复颅眶畸形提供有利的手术条件,提高手术效率,改善患者颅颌面部外形,具有一定的临床应用价值。

PURPOSE: To explore the clinical value of digital 3 D simulation model in precise reconstruction of cranioorbital deformities. METHODS: A retrospective analysis was performed in 44 cases with cranio-orbital malformation from January 2013 to January 2019, 43 had traumatic cranio-orbital deformity and 1 was with congenital cranio-orbital malformation. Among them, patients with deformity were further divided into traditional group and model group. In addition to the traditional group, all patients underwent a thin-slice scan of the skull spiral CT(layer thickness<1.0 mm)preoperatively, the original DICOM image data were collected, and skull three-dimensional data(STL format) were reconstructed by computer digital software. Through rapid prototyping technology and reverse mirror engineering technology, STL data were imported to produce 3 D simulation model. The surgical procedure was simulated by using digital software before surgery, and surgical exercises, pre-bending or pre-implantation materials were performed on the model, to guide the surgical approach and anatomical sites were confirmed during operation. The operation time, symmetry and satisfaction were collected postoperatively, the data was statistically processed using SPSS 25.0 software package.RESULTS: All patients were followed up for 3 months to 6 years, no serious complications such as intracranial hematoma, intracranial infection, blindness, cerebral hernia, and olfactory loss were noted, only 1 patient had cerebrospinal fluid rhinorrhea and recovered after conservative treatment. The operation time of the model group was significantly lower than that of the traditional group(P<0.05). The postoperative satisfaction degree and symmetry of the model group were significantly better than the traditional group(P<0.05). CONCLUSIONS: Digital 3 D simulation model provides accurate medical information before surgery, improving the efficiency and accuracy of surgery and craniofacial shape of the patients.