数字化技术辅助治疗额眶部骨纤维异常增殖症

Digital technology assisted treatment of fronto-orbital fibrous dysplasia

目的探讨数字化技术在额眶部骨纤维异常增殖症患者手术治疗中应用的效果。方法回顾性分析2016年2月和2018年2月中国医学科学院整形外科医院收治的2例额眶部骨纤维异常增殖症患者的临床资料。患者均为男性,年龄分别为18岁和16岁。术前对患者行CT扫描获取影像学数据,导入Mimics 10.01中进行颅骨三维重建和图像分析,设计骨纤维异常增殖症病灶切除范围,然后三维打印头颅缺损模型,并制作覆盖颅骨缺损的个性化钛修复体,再虚拟设计自体颅骨外板取骨范围并模拟修复眶骨缺损。根据设计方案进行手术。术后观察患者恢复情况和并发症发生情况,行头颅CT扫描,测量眶容积、眼球突出度,检查视力,评估手术效果。结果2例患者术中肉眼所见病灶边界与术前模拟设计相符,术中所见颞骨为正常骨质。术后1例患者恢复良好,另1例术后1 d出现脑脊液鼻漏,未经特殊处理,2周后自愈。术后CT显示个性化修复体与颅骨结合良好,额眶部形态满意,接近正常解剖形态。术后2例患侧眶容积增大,比术前分别增加了2.99、9.99 ml;术后眼球突出度得到改善,比术前分别减小3.32、5.11 mm;术后视力与术前相同,眼球各个方向运动良好。患者及家属对形态满意。结论将数字化技术用于额眶部骨纤维异常增殖症术前的模拟设计,有利于术者精确地制定手术计划,提高移植骨的利用效率,术后可获得满意的效果。

Objective To explore the effect of digital technology in the surgical treatment of patients with fronto-orbital fibrous dysplasia.Methods The clinical data of 2 patients with fronto-orbital fibrous dysplasia admitted to the Plastic Surgery Hospital,Chinese Academy of Medical Sciences in February 2016 and February 2018 were retrospectively analyzed.The patients were both male,aged 18 and 16 years,respectively.Preoperative CT scan was performed on the patient to obtain imaging data,imported into Mimics 10.01 for three-dimensional(3D)reconstruction and image analysis of the skull,and the resection range of fibrous dysplasia lesions was designed.Then,the 3D skull defect model was 3D printed,and a personality covering the skull defect was made.Titanium prosthesis was used,and then the bone extraction range of the autologous skull outer plate was designed and simulated to repair the orbital bone defect.Surgery was performed according to the design plan.Postoperatively,the recovery and complications of the patients were observed,skull CT scan was performed,orbital volume,proptosis was measured,visual acuity was checked,and the surgical effect was evaluated.Results The intraoperative macroscopic lesion boundary in 2 patients was consistent with the preoperative simulation design,and the intraoperative temporal bone was normal bone.One patient recovered well after the operation,and the other had cerebrospinal fluid rhinorrhea 1 day after the operation,without special treatment,and recovered spontaneously after 2 weeks.CT scans after the operation showed that the personalized prosthesis was well integrated with the skull,and the shape of the fronto-orbital area was satisfactory,which was close to the normal anatomical shape.The orbital volume of the affected side of 2 cases was enlarged after operation,which increased by 2.99 ml and 9.99 ml respectively compared with that before operation;the exophthalmos were improved after operation,and decreased by 3.32 mm and 5.11 mm respectively compared with that before operation.Directional movement is good.Patients and their families were satisfied with the morphology.Conclusions The use of digital technology in the preoperative simulation design of fronto-orbital fibrous dysplasia is helpful for the operator to accurately formulate the surgical plan,improve the utilization efficiency of the grafted bone,and obtain satisfactory postoperative results.