CT三维重建结合美学理念在儿童小耳畸形全扩张法耳再造中的应用

Application of CT three-dimensional reconstruction combined with aesthetic concept for full expansion auricle reconstruction in children with microtia

目的探讨CT三维重建技术结合美学理念在小耳畸形耳再造术耳支架雕刻组合中的作用。方法自2016年1月至2018年10月对收诊的56例(57侧)先天性小耳畸形患儿均行全扩张法全耳再造术;一期常规在患侧耳后置入扩张器注水扩张;二期手术前用256排螺旋CT扫描患儿双侧肋软骨,配合最大密度投影以及容积的三维重建肋软骨图像,根据每例患儿肋软骨情况切取适量肋软骨,雕刻耳支架。耳支架以耳轮、对耳轮及对耳轮上脚和下脚、耳轮脚、耳舟、三角窝、耳甲腔8个主要亚结构进行雕刻组合,形成3、4层三维立体的耳支架,用扩张好的皮瓣包裹;三期手术对再造耳行耳垂转位以及形态的调整。结果除2例扩张过程中因扩张器外露,通过皮瓣结合植皮完成耳再造术后效果不佳外;其余患儿均顺利完成三期手术,术后获随访6~17个月。再造耳大小、位置与健侧匹配,主要结构及亚结构显现,患儿及家属满意。结论采用CT三维重建技术结合美学理念进行肋软骨切取和耳支架的雕刻组合,可获得更好的耳再造形态效果。

Objective To explore the application of CT three-dimensional reconstruction combined with aesthetic concept for auricular scaffold fabrication in full expansion auricle reconstruction of children with microtia.Methods From January 2016 to October 2018,56 children with microtia were admitted to our department and selected for this study.Full expansion auricle reconstruction was performed in all children.In the first stage of operation,the expander was implanted behind the affected ear and normal saline was injected to expand skin.Before the second stage of operation,bilateral costal cartilages of children were scanned by Philips Brilliance 256 MSCT.The costal cartilage image was reconstructed byMaximum Intensity Projection(MIP)and Volume Rendering Technique(VRT).Then,appropriate costal cartilage was cut for auricular scaffold fabrication according to the situation of each child.The auricular scaffold fabrication consisted of 8 major substructures,including helix,antihelix,superior and inferior crus of antihelix,crus of helix,scapha,triangular fossa and cavum conchae.A three-dimensional auricular scaffold from three to four layers was formed and wrapped by the expanded flap.The earlobe transposition and morphological adjustment of reconstructed auricle were performed in the third stage.Results The operation was in advance in 2 children because of exposure of the expander.The efficacy of auricle reconstruction by flap combined with skin grafting was not good.Three stages of operation have been completed successfully in the remaining children.The postoperative follow-up ranged from 6 to 17 months.The size and position of the reconstructed auricle matched the contralateral side.The main structure and substructure of the reconstructed auricle appeared natural.The children and their parents were satisfactory.Conclusion The application of CT three-dimensional reconstruction combined with aesthetic concept in the costal cartilages resection and auricular scaffold fabrication could acquire good results of auricle reconstruction.