基于逆向工程技术的唇腭裂正畸诊断与治疗

发布时间：2018-04-17 06:31

本文选题：唇腭裂 + 逆向工程技术　；参考：《上海交通大学》2014年博士论文

【摘要】：目的唇腭裂新生儿术前矫治是唇腭裂序列治疗的组成环节之一，本研究以单侧完全性唇腭裂新生儿为研究对象，使用逆向工程技术对传统的术前矫治进行优化和改良，拟建立计算机辅助的术前鼻-牙槽骨塑形治疗体系(CAD-NAM)，模拟治疗目标，辅助治疗设计，采用快速成型技术对矫治器进行个体化定制。准确评价唇腭裂术后患者的颜面软组织形态对了解手术改善鼻唇畸形作用的长期影响具有重要意义，虽然基于头颅定位X线片的头影测量可以在一定程度上获得软组织形态学信息，但是限于二维测量方法的局限性，寻求颜面软组织形态的三维测量方法有助正畸医师获得更准确的信息，为正畸诊断和治疗设计提供良好的数据支持。本研究运用立体照相技术获取青春早期单侧唇腭裂术后患者的颜面软组织形态数据，基于逆向工程方法构建颜面软组织三维数字模型，评价颜面软组织的非对称畸形，探索鼻唇畸形的形态学规律。病例和方法 1.单侧完全性唇腭裂新生儿在监护下制取上颌牙槽印模并翻制石膏模型，对石膏模型进行三维激光扫描，使用Rapidform XOR3构建三维数字模型并模拟CAD-NAM的最终治疗目标，计算牙槽各段的移动距离，分解获得治疗全程各个分解步骤的上颌牙槽数字模型。 2.将各步骤数字模型导入快速原型设备进行三维立体打印，制作分步骤工作模型，根据工作模型制作个体化成品CAD-NAM矫治器。术前矫治期间每次交付患者连续的4副矫治器，每1步骤的矫治器嘱患者佩戴1周，每天佩戴20小时以上。当上颌牙槽突裂裂隙宽度缩小至4mm时在矫治器上加装鼻撑开始鼻翼塑形，该步骤矫治器持续佩戴至唇裂修复手术前，至此CAD-NAM治疗全部完成。 3.收集单侧完全性唇腭裂新生儿病例40例，治疗组患者20例(男性16例，女性4例，初次就诊平均年龄15.81天)，进行CAD-NAM治疗；对照组患者20例(男性15例，女性5例，初次就诊平均年龄123.27天)，在唇裂修复手术前未行任何术前矫治。使用Rapdiform XOR3对两组患者的上颌牙槽数字模型进行形态学测量，使用SPSS15.0对两组患者的测量数据进行描述性统计分析，治疗组在治疗前后各测量指标间做配对t检验，在治疗组治疗后阶段和对照组各测量指标间做独立样本t检验。 4.收集单侧完全性唇腭裂伴牙槽突裂的青少年病例20例作为病例组(男性12例，女性8例，初次就诊时平均年龄11.82岁)；收集非裂健康青少年20例作为对照组(男性10例，女性10例，平均年龄12.00岁)。使用Axis Three’s3D Simulation Platform立体照相设备构建颜面软组织三维数字模型。 5.使用Rapidform XOR3对颜面软组织三维数字模型进行线距和角度测量，，使用SPSS15.0对所得数据进行描述性统计学分析，在两组各测量指标间做独立样本t检验，在病例组的面部双侧测量指标间做配对t检验，在各组内部对涉及鼻孔、鼻翼和上唇的测量指标做皮尔森相关系数分析。 6.使用Geomagic Qualify11.0对单侧唇腭裂伴牙槽突裂术后患者的颜面软组织数字模型做镜像分析和检测，将颜面影像围绕正中矢状面做水平翻转，使左右半侧颜面的影像重叠生成距离映射图，在距离映射图上观测和评价颜面软组织非对称畸形的严重程度和分布。结果 1.单侧完全性唇腭裂新生儿在CAD-NAM治疗前后各测量指标的配对t检验结果提示在水平方向，唇裂裂隙宽度和上颌中线偏斜量等指标在治疗前后的差异具有显著统计学意义，在矢状方向牙弓长度等指标在治疗前后的差异具有统计学意义，在垂直方向乳切牙和乳尖牙区域的牙槽突垂直高度在治疗前后的差异具有显著统计学意义。 2. CAD-NAM治疗组治疗后和对照组在唇裂修复术前各测量指标的独立样本t检验结果提示在水平方向唇裂裂隙宽度和上颌中线偏斜量等指标在两组间的差异具有显著统计学意义，在矢状方向牙弓长度等指标在两组间的差异具有统计学意义，在垂直方向乳切牙和乳尖牙区域的牙槽突垂直高度在两组间的差异具有显著统计学意义。 3.青春早期单侧唇腭裂术后患者颜面软组织形态测量结果提示病例组和正常对照组在鼻孔、鼻翼、鼻小柱和上唇人中等部位的测量数据的组间差异具有显著统计学意义。 4.颜面软组织镜像分析结果提示在距离映射图上的任意点都可以计算得出左右半侧颜面矢状向距离差值。青春早期单侧唇腭裂术后患者面部软组织的不对称区域集中在鼻翼、鼻小柱、上唇和颏部。结论 1. CAD-NAM是一种有效的唇腭裂新生儿术前矫治系统，能够实现精确量化的上颌牙槽骨块移动，节省正畸医师在患者复诊时的椅旁操作时间。 2.对于畸形程度较重的病例CAD-MAN可以有效纠正上颌牙槽形态，使明显前突的牙槽骨前段回纳至正常位置，纠正上颌牙槽中线，缩小牙槽突裂裂隙宽度。 3.但是CAD-NAM可能导致治疗后牙槽高度降低。后续研究将致力于探索CAD-NAM对鼻唇软组织畸形的塑形作用和术前矫治对唇腭裂新生儿上颌牙槽和鼻唇软组织生长发育的长期影响。 4.单侧唇腭裂术后患者在青春早期仍表现出较非裂正常人群更严重的面部软组织不对称，组织畸形集中在鼻唇区域，提示唇腭裂修复手术对鼻唇软组织对称性的改善有限，仍需后期进一步整复。 5.基于立体照相建立的颜面软组织分析方法因无损伤且可重复的优点可以在治疗过程中实现动态追踪，使医生能够及时了解患者颜面软组织的形态变化，距离映射图检测方法可以便捷直观地显示面部不对称的区域分布和严重程度，包括定性判断和定量计算两方面信息，为后续正畸诊断和治疗设计提供数据支持。
[Abstract]:objective
Treatment of newborns with cleft lip and palate before surgery is one of the components of cleft lip and palate team approach, this study takes unilateral cleft lip and palate newborns as the research object, for optimizing and improving the traditional preoperative use of reverse engineering technology, to establish the computer aided preoperative nasal bone remodeling treatment system (CAD-NAM), simulation the treatment goal, adjuvant treatment design, individualized customization of appliance by rapid prototyping technology. The accurate evaluation of cleft lip and palate patients with facial soft tissue morphology to understand the long-term effects of surgery to improve nasolabial deformity effect has important significance, although the cephalometric skull X-ray localization can be obtained soft tissue morphological information in a certain degree based on the limitations but limited to 2D measurement method, 3D measurement method for facial soft tissue morphology can help orthodontists to obtain more accurate information for it The diagnosis and treatment of abnormal design provides a good data support. This research uses stereo camera technology to obtain early puberty in cleft lip and palate patients with facial soft tissue morphological data, construct soft tissue three-dimensional digital model of reverse engineering method based on the asymmetric evaluation of facial soft tissue deformity, morphological features of cleft lip nose exploration.
Cases and methods
1. unilateral cleft lip and palate produced in the neonatal care and turning the maxillary alveolar impression plaster model, 3D laser scanning on the plaster model, a final goal of treatment using Rapidform XOR3 to build the 3D digital model and CAD-NAM simulation of the moving distance calculation of alveolar segments, decomposition of maxillary alveolar digital model treatment throughout each decomposition step.
2. rapid prototyping equipment in the procedure of digital models into 3D printing, making steps work model, according to the working model of the production of individual products CAD-NAM appliance. Preoperative treatment of every period of delivery in 4 side appliance continuous, every 1 steps of the appliance Huanzhe wear 1 weeks, every day wearing more than 20 hours. When the nose is added in the appliance on the maxillary alveolar cleft fissure width shrink to 4mm support to the nose shaping step appliance worn continuously to cleft lip repair surgery, so CAD-NAM treatment was completed.
3. collection of unilateral cleft lip and palate newborns 40 cases, 20 cases of patients in the treatment group (16 cases, 4 cases of male and female first visit an average age of 15.81 days), CAD-NAM treatment; 20 cases of the control group (15 cases, 5 cases of male and female first visit an average age of 123.27 days), without any preoperative correction of cleft lip repair before the operation. The use of Rapdiform XOR3 maxillary alveolar digital model of two groups of patients were measured, using the SPSS15.0 measurement data of two groups of patients were analyzed by descriptive statistical analysis, the treatment group paired t test before and after the treatment of each measurement, in the treatment group and the control group of each measurement stage do independent samples t test.
4. collection of unilateral cleft lip and palate with cleft teenagers in 20 cases as case group (12 cases, 8 cases of male and female first visit an average age of 11.82); collection of non split healthy adolescents in 20 cases as control group (10 cases, 10 cases of male and female with an average age of 12 years) with Axis. Three 's3D Simulation Platform stereo camera equipment to build a three-dimensional digital model of facial soft tissue.
5. using Rapidform XOR3 on facial soft tissue three-dimensional digital model of line distance and angle measurement, using SPSS15.0 descriptive statistical analysis of the obtained data, independent samples t test in two groups of indicators, paired t test in bilateral facial measurement index case group, in each group to measure the internal nostril. The nose and upper lip of the Pearson correlation coefficient.
6. using Geomagic Qualify11.0 for unilateral cleft lip and palate alveolar cleft with postoperative facial soft tissue digital model of patients with image analysis and detection, the facial image around the horizontal flip midsagittal plane, left and right half facial image overlapping generation distance map, observation distance mapping and evaluation of facial soft tissue the severity and distribution of symmetric deformity.
Result
1. unilateral cleft lip and palate neonatal outcome of paired t test in CAD-NAM before and after treatment of each measurement tips in the horizontal direction, the index of cleft lip fracture width and maxillary midline deviation has significant differences in before and after treatment, in the sagittal direction and length of the dental arch were statistically significant differences in before and after treatment, in the vertical the height of alveolar vertical and deciduous incisor region in deciduous teeth difference before and after treatment were statistically significant.
2. CAD-NAM after treatment in the treatment group and the control group in the cleft lip repair before the measurement index of independent samples t test results indicate that the differences in the index of horizontal cleft lip fracture width and maxillary midline deviation in between the two groups was statistically significant in the sagittal direction, the arch length index is the difference between the two groups statistical significance, in the vertical height of alveolar vertical direction and the deciduous incisor deciduous canine regional differences among the two groups was statistically significant.
3. early puberty in cleft lip and palate patients with facial soft tissue morphometry results suggest that patient group and normal control group in the nose, nose, there was a statistically significant difference measurement data of the columella secondary parts of the group.
4. soft tissue image analysis showed that in the distance of any point on the map can be calculated about semifacial sagittal distance difference. The asymmetric Regional Youth early cleft lip and palate patients with facial soft tissue in the nasal columella, upper lip and chin.
conclusion
1. CAD-NAM is an effective pre-operative orthodontic system for cleft lip and palate neonates. It can achieve precise quantification of alveolar bone movement in the maxilla and save time for orthodontic doctors when they return to the clinic.
2., for the cases with severe deformity, CAD-MAN can effectively correct the maxillary alveolar morphology, make the anterior segment of the anterior alveolar bone return to the normal position, correct the upper alveolar midline and reduce the width of the alveolar cleft.
3., however, CAD-NAM may lead to decreased alveolar height after treatment. Follow-up studies will explore the long-term effect of CAD-NAM on the growth and development of maxillary alveolar and nasolabial soft tissues in patients with cleft lip and palate.
4. patients with unilateral cleft lip and palate still showed more severe facial soft tissue asymmetry in early puberty than normal subjects. The tissue deformity was concentrated in the nasolabial region, suggesting that the repair of lip and palate is limited to the improvement of the symmetry of the nasolabial soft tissue, and it still needs further restitution.
5. soft tissue based on the analysis method of stereoscopic photography because of the advantages of no injury and repeatable can realize dynamic tracking in the treatment process, so that doctors can timely understand the morphological changes in patients with facial soft tissue, distance map detection method can be convenient to visually display the regional distribution of facial asymmetry and severity, including qualitative judgment and quantitative analysis of two aspects of information, provide data support for the subsequent orthodontic diagnosis and treatment design.

【学位授予单位】：上海交通大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R782.2

【共引文献】