三维数字化技术辅助牵引成骨术治疗新生儿Pierre Robin序列征的临床研究

Clinical study of three-dimensional digital technique-assisted distraction osteogenesis in newborns with Pierre Robin sequence

目的:探讨三维数字化技术辅助牵引成骨术治疗新生儿Pierre Robin序列征的临床效果。方法:回顾性分析南京医科大学附属儿童医院2017年4月至2020年4月收治的采用三维数字化技术辅助牵引成骨术治疗的新生儿Pierre Robin序列征的病例资料,设为三维数字化辅助组。术前采用三维数字化技术辅助手术设计,制作并3D打印截骨导板,完成下颌骨截骨术。以2010年1月至2017年1月收治的未采用三维数字化技术辅助手术的新生儿Pierre Robin序列征患儿病例资料为对照。术后3个月复查颅面CT,了解下颌骨生长情况,对复发率、延长器钛钉脱落率、感染率、二次手术率、神经损伤发生率进行统计学分析。计数资料组间比较采用χ^(2)检验,对术后并发症的独立影响因素采用多元logistic回归分析,P<0.05表示差异有统计学意义。结果:三维数字化技术辅助组共纳入345例患儿,男215例,女130例,年龄3~28 d,体质量1.8~3.2 kg,所有患儿手术顺利,效果满意,与术前设计非常接近。术后3个月复查颅面CT示下颌骨正常生长。对照组共纳入377例患儿,男230例,女147例,年龄6~28 d,体质量1.6~3.6 kg。三维数字化技术辅助组复发率、延长器钛钉脱落率、二次手术率、神经损伤发生率分别为0.29%(1/345)、0.29%(1/345)、0.58%(2/345)、0.29%(1/345),明显低于对照组的1.86%(7/377)、2.92%(11/377)、2.65%(10/377)、2.92%(11/377),差异均有统计学意义(P<0.05);2组的感染率分别为7.83%(27/345)和7.69%(29/377),差异无统计学意义(P>0.05);多元logistic回归分析结果提示三维数字化技术干预可作为降低术后并发症的独立保护因素(P=0.001)。结论:在牵引成骨术治疗新生儿Pierre Robin序列征中采用三维数字化技术辅助术前设计和制作截骨导板,可以显著提高手术的精准度和成功率,降低并发症发生率。

Objective To investigate clinical effects of the three-dimensional(3D)digital technique-assisted distraction osteogenesis in newborns with Pierre Robin sequence(PRS).Methods The data of neonatal Pierre Robin sequence treated with 3D digital technique-assisted distraction osteogenesis in Children’s Hospital Affiliated to Nanjing Medical University from April 2017 to April 2020 was retrospectively analyzed.3D digital technique was used to assist the pre-operative design and osteotomy navigation template was made with 3D printing technique to guide in the mandibular osteotomy.CT scans were obtained 3 months postoperatively to follow up the growth of mandible.The rates of recurrence,titanium nail falling,infection,secondary operation and nerve injury were statistically analyzed.The counting data were analyzed using chi-square test.The independent influencing factors of postoperative complications were analyzed by multiple logistic regression,and the difference was statistically significant when P<0.05.Results Three hundred and forty-five patients were included in the 3D digital technique group consisting of 215 males and 130 females with the ages ranged 3-28 days and the weights 1.8-3.2 kg.Surgical results were satisfied and very close to the preoperative design.Craniofacial CT results showed normal growth of mandible 3 months postoperatively.Three hundred and seventy-seven patients were included in the controlled group consisting of 230 males and 147 females with the ages ranged 6-28 days and the weights 1.6-3.6 kg.The recurrence rate,extender titanium nail off rate,reoperation rate and risk of nerve damage in the 3D digital technique group were 0.29%(1/345),0.29%(1/345),0.58%(2/345)and 0.29%(1/345),respectively,while in the control group,the numbers were 1.86%(7/377),2.92%(11/377),2.65%(10/377),2.92%(11/377),respectively,which were significant lower than those in the 3D group.The infection rates were 7.83%(27/345)in the 3D digital technique group and 7.69%(29/377)in the control group,and there was no significant difference between the two groups.The results of multi-logistic regression analysis suggested that the 3D digital technique group could be an independent factor to reduce postoperative complications(P=0.001).Conclusions In the newborns with Pierre Robin sequence,3D digital technique-assisted distraction osteogenesiscan significantly improve the accuracy and success rate of the operation and reduce the complication rate as well.