Craniofacial malformation caused by premature fusion of cranial suture of infants has a serious impact on their growth. The purpose of skull remodeling surgery for infants with craniosynostosis is to expand the skull and allow the brain to grow properly. There are no standardized treatments for skull remodeling surgery at the present, and the postoperative effect can be hardly assessed reasonably. Children with sagittal craniosynostosis were selected as the research objects. By analyzing the morphological characteristics of the patients, the point cloud registration of the skull distortion region with the ideal skull model was performed, and a plan of skull cutting and remodeling surgery was generated. A finite element model of the infant skull was used to predict the growth trend after remodeling surgery. Finally, an experimental study of surgery simulation was carried out with a child with a typical sagittal craniosynostosis. The evaluation results showed that the repositioning and stitching of bone plates effectively improved the morphology of the abnormal parts of the skull and had a normal growth trend. The child’s preoperative cephalic index was 65.31%, and became 71.50% after 9 months’ growth simulation. The simulation of the skull remodeling provides a reference for surgical plan design. The skull remodeling approach significantly improves postoperative effect, and it could be extended to the generation of cutting and remodeling plans and postoperative evaluations for treatment on other types of craniosynostosis.
Objective To analyze clinicopathologic characteristics of 1 008 patients with gallbladder polyps by minimally invasive gallbladder-preserving surgery, and to explore hemostatic effect of 0–4 ℃ cold saline plus different concentrations norepinephrines in flushing gallbladder mucosa bleeding. Methods The clinical data of 1 008 patients with gallbladder polyps by the minimally invasive gallbladder-preserving surgery from 2009 to 2016 in the General Hospital of Xinjiang Military Command were retrospectively analyzed. The clinicopathologic types of gallbladder polyps and the relationship between the operation time and the recurrence of gallbladder polyps were analyzed, the hemostatic effects of 0–4 ℃ cold saline plus different concentrations (0, 16, 24, and 30 mg/L) norepinephrines in flushing gallbladder mucosa bleeding (The hemostatic effect was reflected by the time of flushing gallbladder mucosa bleeding) were compared. Results One thousand patients with non-tumorous gallbladder polyps successfully underwent the minimally invasive gallbladder-preserving surgery, another 8 cases patients with tumorous gallbladder polyps underwent the cholecystectomy immediately. There were 128 cases of single polyps and 880 cases of multiple polyps. The polyp diameters of 910 cases were 5–10 mm and 98 cases were 10–15 mm. The pathological analysis indicated that there were 912 (90.5%) cases of the cholesterol polyps, 74 (7.3%) cases of the inflammatory polyps, 14 (1.4%) cases of the adenoid hyperplasia, and 8 (0.8%) cases of the neoplastic polyps ［adenoma 6 cases, adenocarcinoma (T0N0M0) 2 cases］. The gallbladder polyps recurrences were found in 30 (3.0%) cases during 1–8 years of follow-up (average 4 years), all of them were the multiple and cholesterol polyps. The flushing gallbladder mucosa bleeding time of 0–4 ℃ cold saline plus 0, 16, 24, and 30 mg/L concentraions norepinephrine was (44±5) min, (33±6) min, (17±5) min, and (17±4) min in the 125, 230, 555, and 98 patients with gallbladder polyps, respectively. The time of flushing gallbladder mucosa bleeding between the other concentration groups had significant difference (P<0.05) except for between the 24 mg/L concentration group and the 30 mg/L concentration group (P>0.05). The operation time was (62±21) min and (60±19) min of the 30 patients with gallbladder polyps recurrence and the 970 patients without gallbladder polyps recurrence, which had no significant difference (P>0.05). Conclusions Cholesterol polyp is a common pathological type of gallbladder polyp, inflammatory polyp and adenomyosis polyp are uncommon, and multiple polyps are common. Hemostatic effects of 0–4 ℃ cold saline plus different concentraions norepinephrine in flushing gallbladder mucosa bleeding are desirable, expecially at a 24 mg/L concentraion norepinephrine is the most effective. No correlation is found between operation time and recurrence of gallbladder polyp.