The Reconstructive Operation Of Craniosynostosis Based On Three Digital Technology

Objective:1.Based on the digital technology,the objective measurement method of bone tissue,soft tissue and brain volume in the patients with craniosynostosis was explored,and the surgical effect of different orbital advancement methods were evaluated quantitatively.2.Based on three-dimensional computerized design and manufacturing technology personalized precision surgery was designed,and according to preoperative simulation,the navigation guide was manufactured,and evaluation of navigation effects quantitatively.3.The three-dimensional finite element model of craniotomy was established,and its biomechanical characteristics were analyzed to illustrate the physiopathologic mechanism.Methods:1.12 patients with craniosynostosis who were treated between January 2010 and March 2017 were selected.The bone,soft tissue and brain tissue of the skull were reconstructed according to the DICOM data of the head CT before operation,postoperative and follow-up.2.Three cases with craniosynostosis who were treated with maxillofacial plastic surgery from August 2014 to December 2016 were selected.CT images were used to design the surgical osteotomy program and determine the position of the bone flap.The guide plate was used to reduce the time of reposition,the surgical outcomes were assessed quantitatively.3.The finite element analysis of skull in children with craniosynostosis was carried out by using three-dimensional digitalization technique.The hysiopathologic mechanism was analyzed by finite element analysis of skull biomechanics.Results:1.Significant differences were found in the measurement indicators as follows comparing preoperation and follow-up:the ratio of CSX ?,CX,SX,XSM ?,S-Pt,XM,SM,the frontal angle,the frontal angle,the ipsilateral temporal angle and the temporal angle.There were statistically significant differences between preoperative brain volume and postoperative brain volume.There was no statistically significant difference between the volume of the brain and the control group at the time of follow-up.The change of the bone flap advance:the bilateral fronto-orbital advancement was better than the unilateral frontal orbital advancement.Unilateral orbital advancement in the correction of temporal deformity.2.The time of reposition was about 0.5 hours to 1 hour,the movements of markers in surgical area when preoperative simulation is similar as the distance measured after surgery.3.A three-dimensional finite element model was established.It can be seen that there were many stress concentration areas such as anterior cranial fossa,the middle frontal and left temporal.What's more,the stress distribution of the cranial base was concentrated.However,the finite element models which simulated fronto-orbital advancement proved that the stress of the cranial base was mitigated after surgery.Conclusion:1.The bone tissue and soft tissue of the cranial skull,the symmetry of skull base were abnormal,the brain volume was lower than normal,and the deformity of the fronto-temporal was improved.It can improve the temporal deformity using bilateral fronto-orbital advancement.2,By using digital technology,preoperative simulation can be performed to assist the craniotomy and fabricate navigational plate.It can improve the accuracy and safety of surgery.3,The finite element model of craniosynostosis can be easier to understand the pathophysiological changes.the finite element models simulating fronto-orbital advancement can help us make surgical decision and predict the force and direction of distraction osteogenesis.