单侧冠状缝早闭症整复手术的三元有限元生物力学分析（英文）

作者：陈丽丹; 杨斌^*

来源：中国整形与重建外科(英文), 2019, 1(01): 24-30.

Objective To establish finite element models of skull, fronto-orbital advancement and fronto-orbital distraction osteogenesis of craniosynostosis, to analyze the mechanical characteristics of skull base and fronto-orbital operation area, so as to guide the later application of distractors. Methods One 6-year-old male patient with unilateral coronal synostosis was enrolled in October 2015. Three-dimensional(3 D) computed tomography(CT) scan of skull was performed. DICOM data was imported into Mimics 17.0 for contour extraction and cranial 3 D reconstruction. The skull model was processed by Mimics, Geomagic Studio 12.0, Hypermesh 12.0 and other software to establish a three-dimensional finite element model. The unilateral and bilateral fronto-orbital anterior osteotomy models were simulated respectively. The mechanical analysis was performed at point A in forehead area and point B in temporal area. Three different groups of traction forces were loaded:(1) 50 Newton for point A, 50 Newton for point B;(2) 80 Newton for point A and 50 Newton for point B;(3) 100 Newton for point A and 50 Newton for point B, to obtain the optimized traction force.. Results Stress analysis was performed on established cranial finite element model, as well as unilateral and bilateral fronto-orbital advancement procedures. The stress distribution of the anterior and middle cranial fossae was found to be concentrated. After unilateral fronto-orbital advancement, the stress of anterior cranial fossa, especially the affected side, was decreased. The stress on both side in anterior cranial fossa was decreased after bilateral fronto-orbital advancement. After force was applied to point A and point B, the optimum deviation result at supraorbital notch point, midpoint of supraorbital margin, frontal temporal point and frontal zygomatic suture point in 3 D(Deviation result of X value:-29.4%,-20.5%,-8.6%,-9.3%, Deviation result of Y value: 20.9%, 31.5%, 73.0%, 539.4%; Deviation result of Z value: 4.4%, 1.9%, 0.1%, 11.8) demonstrated the application of traction force can inwardly, downwardly and forwardly move the bone flap. The optimized traction was 80 N at point A and 50 N at point B by preliminary assessment. Conclusion The finite element analysis of the fronto-orbital advancement can be used for more accurate preoperative simulation, to clarify the influence of fronto-orbital advancement on craniofacial morphology and development, as well as skull base. It also facilitates surgical decision and predicts the postoperative distraction vectors

• 单位
  中国医学科学院北京协和医院; 北京协和医学院