摘要目的:初步探讨基于头颅3D打印模型的术前设计在非综合征性颅缝早闭手术中的应用。方法:回顾性分析2020年6月至2021年9月西北妇女儿童医院神经外科行手术治疗的7例非综合征性颅缝早闭患儿的临床资料。患儿的月龄为4~12个月，头颅外形均明显畸形，且均经头颅CT确诊，其中额缝早闭1例，单侧冠状缝早闭2例，单侧人字缝早闭2例，矢状缝早闭2例。术前制作1 ∶1 3D打印颅骨模型，基于模型进行手术计划、模拟和矫正，并制作跨手术颅骨区域的金属导板，以作为术中引导工具。其中6例采用颅缝再造术和颅骨重建术，1例仅采用颅缝再造术。采用标准头颅测量法测量患儿轴位头颅CT显示畸形最明显的层面，并获取0~180°范围(间隔10°)、共计19个维度的颅骨轮廓径距值(SDD)。比较术后与术前头颅CT同层面SDD的变化，评估术后颅腔扩张的程度和外观形变情况。结果:7例患儿术后行头颅CT三维重建显示，头颅畸形均得到良好矫治，且与术前设计的头颅整复效果完全匹配。患儿术前左、右侧SDD比较差异有统计学意义( P＝0.017)；术后左、右侧SDD比较差异无统计学意义( P＝0.317)，头颅左、右对称度明显改善；术后头颅整体(左侧+右侧)SDD与术前比较明显增大[分别为(5.541±1.104)cm、(5.342±1.180)cm]，差异有统计学意义( P＝0.009)。7例患儿的随访时间为1~15个月，末次随访头颅CT三维重建显示，头颅外形均稳定对称。家属满意度分值：7分2例，9分5例。 结论:基于头颅3D打印模型的术前计划和制作跨手术颅骨区域的金属导板，有助于实现术中操作与术前设计的精准匹配，术后头颅畸形可得到良好矫正。

abstractsObjective:To preliminarily investigate the role of presurgical design based on 3D printed skull model in surgery of non-syndromic craniosynostosis.Methods:The clinical data of 7 children with nonsyndromic craniosynostosis who underwent surgical treatment in the Department of Neurosurgery of Northwestern Women′s and Children′s Hospital from June 2020 to September 2021 were retrospectively analyzed. The age of the children was 4 to 12 months, and the skull shape was obviously deformed, and all were diagnosed by head CT. Among them, there were 1 case of premature closure of the frontal suture, 2 cases of unilateral premature closure of the coronal suture, and 2 cases of unilateral premature closure of the lambdoidal suture, and 2 cases of premature closure of the sagittal suture. A 1 ∶1 3D printed skull model was made preoperatively, surgical planning, simulation and correction were performed based on the model, and a metal guide across the surgical skull area was made as an intraoperative guidance tool. In this series, 6 cases underwent cranial suture reconstruction and skull reconstruction, and 1 case only underwent cranial suture reconstruction. Standard cephalometric measurements were used to measure the most obvious level of deformity on axial CT of each child′s head, and the skull contour diameter distance (SDD) in 19 dimensions in the range of 0° to 180° (interval of 10°) was obtained. The changes of SDD at the same level of head CT between preoperative and postoperative conditions were analyzed, and the degree of postoperative cranial cavity expansion and appearance change were evaluated.Results:Pos-toperative CT three-dimensional reconstruction of 7 children showed that the head deformities were well corrected and completely matched with the preoperative design of skull reconstruction. There was a statistically significant difference in the SDD between the left and right sides of the children before operation ( P=0.017); there was no significant difference in the SDD between the left and right sides after operation ( P=0.317), and the left and right cranial symmetry was significantly improved. The SDD of the whole skull (left + right) was significantly increased compared with preoperative (5.541±1.104 cm vs. 5.342±1.180 cm), and the difference was statistically significant ( P=0.009). The follow-up time of 7 children was 1 to 15 months. The three-dimensional reconstruction of head CT at the last follow-up showed that the skull shape was stable and symmetrical. The parents′ satisfaction score was 7 points in 2 cases and 9 points in 5 cases. Conclusions:The preoperative planning based on the 3D printed model of the skull and the production of metal guides across the cranial surface osteotomy area help to achieve accurate matching of intraoperative operations and preoperative design, and the skull deformity can be well corrected after surgery.