使用头颅CTA数据三维立体重建打印床突段动脉瘤及前床突模型应用于动脉瘤夹闭术

Three-dimensional reconstruction and printing of clinoid process aneurysm and anterior clinoid process model with cranial CTA data in aneurysm clipping

目的 探讨头颅血管造影(CTA)数据三维立体重建打印床突段动脉瘤及前床突模型在动脉瘤夹闭术患者中的应用效果。方法 选择2018年4月至2020年2月动脉瘤夹闭术患者86例为对象,随机数字表法分为两组,各43例。对照组根据普通CTA检查结果,结合临床经验进行手术治疗,观察组术前使用头颅CTA数据三维立体重建打印床突段动脉瘤及前床突模型,指导手术治疗,术后7 d对患者效果进行评估,并完成6个月随访,比较两组手术效果、围术期并发症及随访结果。结果 观察组43例患者夹闭术成功41例,成功率95.35%,对照组43例患者夹闭成功35例,成功率81.40%(P<0.05);观察组完全夹闭率高于对照组(P<0.05);瘤颈残余、瘤体残余率低于对照组(P<0.05);观察组围术期术后血管痉挛、血肿、静脉血栓、肢体活动障碍及颅内水肿发生率6.99%,低于对照组的16.29%(P<0.05);观察组最终随访40例,随访期间38例患者恢复良好,能自理生活;2例患者伴有轻度神经功能障碍;对照组最终随访38例,随访期间30例患者恢复良好,8例患者伴有轻度神经功能障碍。结论 头颅CTA数据三维立体重建打印床突段动脉瘤及前床突模型用于动脉瘤夹闭术患者中能获得良好的手术效果,术后并发症较低,能降低术后复发率。

Objective To explore the application effect of three-dimensional reconstruction and printing of clinoid process aneurysm and anterior clinoid process model with cranial CT angiography(CTA) data in patients after aneurysm clipping. Methods A total of 86 patients underwent aneurysm clipping from April 2018 to February 2020 were selected. They were divided into two groups using random number table, with 43 patients in each group. The control group were given surgical treatment based on the results of ordinary CTA examinations combined with clinical experience.The observation group were given preoperative three-dimensionally reconstruct and printing of clinoid process aneurysm and anterior clinoid process model with cranial CTA data to guide the surgical treatment. The patients were evaluated at 7 days after the surgery and 6-month follow-up to compare the surgical effects, perioperative complications, and follow-up results between the two groups. Results A total of 41 out of 43 patients in the observation group were successfully clipped with a success rate of 95.35%, which was higher than that in the control group as 81.40%, in which 35out of 43 patients were successfully clipped(P<0.05). The complete clipping rate in the observation group was higher than that in the control group(P<0.05). The residual rate of aneurysm neck and body in the observation group was lower than that in the control group(P<0.05). The incidence rate of perioperative and postoperative vasospasm, hematoma,venous thrombosis, limb dysfunction and intracranial edema in the observation group was 6.99%, which was lower than that in the control group as 16.29%(P<0.05). A total of 40 patients in the observation group completed follow-up, among whom 38 patients recovered well and were able to take care of themselves, and 2 patients had mild neurological dysfunction. A total of 38 patients in the control group completed follow-up, among whom 30 patients recovered well,and 8 patients had mild neurological dysfunction. Conclusion Three-dimensional reconstruction and printing of clinoid process aneurysm and anterior clinoid process model with cranial CTA data has good surgical results in patients after aneurysm clipping surgery, with low postoperative complications. It can also reduce postoperative recurrence rate.