目的:单冠状颅骨融合(UCS)的特征是复杂的眼眶畸形,通常在生命的第一年通过不对称的前眶重塑(FOR)治疗。这项研究的目的是阐明手术治疗在多大程度上矫正了眼眶形态。
方法:通过分析滑膜,非突触,并在两个时间点控制轨道。总的来说,从术前获得的患者CT图像(平均年龄9.3个月)分析147个轨道,随访时(平均年龄3.0岁),在匹配的控件中。使用半自动分割软件确定眼眶体积。为了分析轨道形状和不对称性,几何模型,签名距离地图,主要的变化模式,和三个客观参数(平均绝对距离,Hausdorff距离,和骰子相似系数)通过统计形状建模生成。
结果:在随访时,滑膜侧和非滑膜侧的眼眶体积均明显小于对照组,在术前和随访时均明显小于非滑膜侧的眼眶体积。在全球和局部发现了形状的显著差异,术前和3岁。与对照组相比,在两个时间点,主要在天气侧发现偏差。在随访时,滑膜侧和非滑膜侧之间的不对称性显着降低,但与对照组固有的不对称性相比。在团体层面,术前滑膜轨道主要在前上和前下区域扩张,在颞侧最小。在后续行动中,平均滑膜轨道仍然较大,但在前下颞区也扩大了。总的来说,非滑膜轨道的形态与对照相比更相似。然而,在随访中,非融合性轨道的轨道形状的个体差异最大。
结论:在这项研究中,作者提出了什么是,根据他们的知识,在UCS中首次对轨道形状进行客观自动3D骨评估,比以前更详细地定义了滑音轨道与非滑音轨道和控制轨道的区别,以及从术前9.3个月到术后随访时3岁的眼眶形状如何变化。尽管进行了手术治疗,局部和全局的形状偏差仍然存在。这些发现可能对外科治疗的未来发展方向具有启示意义。未来的研究将眼眶形态学与眼科疾病联系起来,美学,和遗传学可以提供进一步的见解,使更好的结果在UCS。
OBJECTIVE: Unicoronal craniosynostosis (UCS) is characterized by complex orbital deformity and is typically treated by asymmetrical fronto-orbital remodeling (FOR) during the 1st year of life. The aim of this study was to elucidate to what extent orbital morphology is corrected by surgical treatment.
METHODS: The extent to which orbital morphology was corrected by surgical treatment was tested by analysis of differences in volume and shape between synostotic, nonsynostotic, and control orbits at two time points. In total, 147 orbits were analyzed from patient CT images obtained preoperatively (mean age 9.3 months), at follow-up (mean age 3.0 years), and in matched controls. Semiautomatic segmentation software was used to determine orbital volume. For analysis of orbital shape and asymmetry, geometrical models, signed distance maps, principal modes of variation, and three objective parameters (mean absolute distance, Hausdorff distance, and dice similarity coefficient) were generated by statistical shape modeling.
RESULTS: Orbital volumes on both the synostotic and nonsynostotic sides were significantly smaller at follow-up than volumes in controls and significantly smaller both preoperatively and at follow-up than orbital volumes on the nonsynostotic side. Significant differences in shape were identified globally and locally, both preoperatively and at 3 years of age. Compared with controls, deviations were mostly found on the synostotic side at both time points. Asymmetry between synostotic and nonsynostotic sides was significantly decreased at follow-up, but not compared with the inherent asymmetry of controls. On a group level, the preoperative synostotic orbit was mainly expanded in the anterosuperior and anteroinferior regions and smallest on the temporal side. At follow-up, the mean synostotic orbit was still larger superiorly but also expanded in the anteroinferior temporal region. Overall, the morphology of nonsynostotic orbits was more similar to that of controls than to synostotic orbits. However, the individual variation in orbital shape was greatest for nonsynostotic orbits at follow-up.
CONCLUSIONS: In this study, the authors presented what is, to their knowledge, the first objective automatic 3D bony evaluation of orbital shape in UCS, defining in greater detail than has been done previously how synostotic orbits differ from nonsynostotic and control orbits, and how orbital shape changes from 9.3 months of age preoperatively to 3 years of age at the postoperative follow-up. Despite surgical treatment, both local and global deviations in shape persist. These findings may have implications for future directions in the development of surgical treatment. Future studies connecting orbital morphology to ophthalmic disorders, aesthetics, and genetics could provide further insight to enable better outcomes in UCS.