CT三维重建技术在颅骨缺损修补术中的应用(1)
摘 要：目的 探讨CT三维重建技术在颅骨缺损修补术中的临床价值。方法 收集2013年3月～2016年4月行钛板颅骨缺损修补术患者11例。均于术前采用螺旋CT薄层扫描和颅骨三维成像，根据CT采集的数据进行颅骨缺损部位的数字化模拟塑形，制作出成型三维钛板。根据术中钛板与颅骨缺损吻合程度、术后头颅外形对称性评价钛骨嵌合度是否良好，根据患者满意程度、外观美感、咬合感、头部舒适度等医患互动方式评价手术效果是否满意。结果 11例患者手术顺利，无一例出现术后感染。仅1例(9.09%)术后并发硬膜外积液。所有的塑形钛板均与颅骨缺损部嵌合度良好，患者的手术效果满意度为100.00%。结论 利用CT三维重建技术的成型钛板具有良好的嵌合度，且手术效果佳，该CT技术在颅骨缺损修补术中具有临床实用价值。
关键词：颅骨缺损；修补术；体层摄影术；X线计算机；三维重建
中图分类号：R651.1 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.12.053
, 百拇医药
文章编号：1006-1959(2018)12-0166-02
Abstract：Objective To evaluate the clinical value of CT three-dimensional reconstruction in the repair of skull defect.Methods From March 2013 to April 2016，11 patients underwent titanium plate cranial defect repair. Spiral CT thin slice scanning and three-dimensional imaging of skull were used before operation.According to the data collected by CT，the digital simulation of skull defect was performed，and the three-dimensional titanium plate was made.According to the degree of anastomosis between the titanium plate and the skull defect during the operation and the symmetry of the skull shape after operation，the degree of titanium chimera was evaluated，according to the satisfactory degree of the patient，the aesthetic sense of appearance， the sense of occlusal，head comfort and other doctor-patient interaction to evaluate the results of surgery was evaluated.Results 11 cases were successfully operated and no postoperative infection occurred in 1 case.Only 1 cases(9.09%)had epidural effusion after operation.All the plastic titanium plates were in good chimerism with the skull defect.The satisfaction of the patientundefineds operation effect was 100.00%.Conclusion The use of CT three-dimensional reconstruction technology for the formation of titanium plate has a good degree of chimerism，and a good surgical effect，the CT technology has a clinical practical value in the repair of skull defects.
, 百拇医药
Key words：Skull defect；Repair；Tomography；X-ray computer；Three-dimensional reconstruction
神经外科医师实施去骨瓣手术后造成的颅骨缺损是常见的术后遗留问题，如何完美修复颅骨缺损，如何更快的恢复神经功能障碍，是临床迫切需要解决的实际问题。然而，传统颅骨修补术于术中评估缺损程度、对钛网手工塑形，往往手术创面较大，钛骨嵌合度欠佳，术后并发症较多[1，2]。近年来根据CT薄层扫描数据和三维重建技术模拟缺损部位的曲度和形状，从而进行个性化设计塑形钛板，临床应用效果较好，本研究旨在探讨该CT技术对于此成型钛板颅骨修补术中的临床应用价值。
1 资料与方法
1.1一般资料 收集合肥市第五人民医院2013年3月～2016年4月收治的颅骨缺损修补术患者11例，男4例，女7例，年龄41～65岁，中位年龄51岁。其中颅脑损伤术后缺损10例，高血压脑出血术后缺损1例。额颞部缺损8例，颞部缺损1例，颞顶部缺损1例，额顶部(双侧)缺损1例。11例患者中，2例采用单排螺旋CT机进行扫描，9例采用64排128层螺旋CT进行扫描。
, 百拇医药
1.2 CT扫描方法及钛板处理 西门子单排螺旋CT机扫描参数设置为管电压120 kV，重建层厚和间隔1.0 mm，西门子SOMATOM Definition AS+64排128層螺旋CT扫描参数设置为管电压120 kV，重建层厚和间隔0.625 mm，均对全颅骨进行骨窗薄层扫描。将采集到的数据传入后处理工作站进行重建，单排螺旋CT应用CT表面遮盖法(surface shaded display，SSD)、多排螺旋CT应用容积重建(volume rendering，VR)对颅骨进行三维成像，把得到的颅骨完整的薄层和三维重建数据刻盘后发给钛板生产公司，生产出与患者颅骨缺损的CT三位重建图像完全一致的塑形钛板，高压灭菌备用。患者均在气管插管全麻下作颅骨缺损修补手术，沿原手术切口进入，术中充分显露颅骨骨窗，直接将塑形钛板固定于骨窗处，术后皮下放置引流管持续引流[2]。, 百拇医药(李静 张微微 蒋威)
关键词：颅骨缺损；修补术；体层摄影术；X线计算机；三维重建
中图分类号：R651.1 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.12.053
, 百拇医药
文章编号：1006-1959(2018)12-0166-02
Abstract：Objective To evaluate the clinical value of CT three-dimensional reconstruction in the repair of skull defect.Methods From March 2013 to April 2016，11 patients underwent titanium plate cranial defect repair. Spiral CT thin slice scanning and three-dimensional imaging of skull were used before operation.According to the data collected by CT，the digital simulation of skull defect was performed，and the three-dimensional titanium plate was made.According to the degree of anastomosis between the titanium plate and the skull defect during the operation and the symmetry of the skull shape after operation，the degree of titanium chimera was evaluated，according to the satisfactory degree of the patient，the aesthetic sense of appearance， the sense of occlusal，head comfort and other doctor-patient interaction to evaluate the results of surgery was evaluated.Results 11 cases were successfully operated and no postoperative infection occurred in 1 case.Only 1 cases(9.09%)had epidural effusion after operation.All the plastic titanium plates were in good chimerism with the skull defect.The satisfaction of the patientundefineds operation effect was 100.00%.Conclusion The use of CT three-dimensional reconstruction technology for the formation of titanium plate has a good degree of chimerism，and a good surgical effect，the CT technology has a clinical practical value in the repair of skull defects.
, 百拇医药
Key words：Skull defect；Repair；Tomography；X-ray computer；Three-dimensional reconstruction
神经外科医师实施去骨瓣手术后造成的颅骨缺损是常见的术后遗留问题，如何完美修复颅骨缺损，如何更快的恢复神经功能障碍，是临床迫切需要解决的实际问题。然而，传统颅骨修补术于术中评估缺损程度、对钛网手工塑形，往往手术创面较大，钛骨嵌合度欠佳，术后并发症较多[1，2]。近年来根据CT薄层扫描数据和三维重建技术模拟缺损部位的曲度和形状，从而进行个性化设计塑形钛板，临床应用效果较好，本研究旨在探讨该CT技术对于此成型钛板颅骨修补术中的临床应用价值。
1 资料与方法
1.1一般资料 收集合肥市第五人民医院2013年3月～2016年4月收治的颅骨缺损修补术患者11例，男4例，女7例，年龄41～65岁，中位年龄51岁。其中颅脑损伤术后缺损10例，高血压脑出血术后缺损1例。额颞部缺损8例，颞部缺损1例，颞顶部缺损1例，额顶部(双侧)缺损1例。11例患者中，2例采用单排螺旋CT机进行扫描，9例采用64排128层螺旋CT进行扫描。
, 百拇医药
1.2 CT扫描方法及钛板处理 西门子单排螺旋CT机扫描参数设置为管电压120 kV，重建层厚和间隔1.0 mm，西门子SOMATOM Definition AS+64排128層螺旋CT扫描参数设置为管电压120 kV，重建层厚和间隔0.625 mm，均对全颅骨进行骨窗薄层扫描。将采集到的数据传入后处理工作站进行重建，单排螺旋CT应用CT表面遮盖法(surface shaded display，SSD)、多排螺旋CT应用容积重建(volume rendering，VR)对颅骨进行三维成像，把得到的颅骨完整的薄层和三维重建数据刻盘后发给钛板生产公司，生产出与患者颅骨缺损的CT三位重建图像完全一致的塑形钛板，高压灭菌备用。患者均在气管插管全麻下作颅骨缺损修补手术，沿原手术切口进入，术中充分显露颅骨骨窗，直接将塑形钛板固定于骨窗处，术后皮下放置引流管持续引流[2]。, 百拇医药(李静 张微微 蒋威)