数字化技术在“L型”颧骨降低术的分析及应用研究

发布时间：2018-04-25 01:05

本文选题：L型颧骨截骨降低术 + 数字化技术　；参考：《北京协和医学院》2015年博士论文

【摘要】：目的1.应用整形外科最普遍医学图像资料——数字化照片对行L型颧骨截骨降低术患者手术前术后颧部轮廓变化进行客观定量的测量分析。2.分别对三维CT重建图像及二维CT断层图像进行测量,探索和总结L型颧骨截骨降低术后颅颌面骨性结构的变化。3.应用数字化外科技术辅助单侧颧骨L型截骨降低术用以矫正颧骨不对称畸形,提高手术的精确性及安全性。方法1.标准化采集受试者数字化照片,提出颧部轮廓测量评价方法并测量高颧骨患者术前术后及正常貌美人群相关数据,客观定量评价L型颧骨截骨降低术后颧部轮廓的变化。2.运用人体测量学的相关原理分别对高颧骨患者的术前术后三维CT重建图像以及断层CT影像进行测量分析,研究L型颧骨截骨降低术前后颧骨相关宽度、突度、角度和比例等颅颌面骨性参数的变化。3.运用数字化外科技术,对双侧颧骨不对称患者的影像学数据进行三维重建、在数字化外科平台上进行个性化的手术设计和模拟,制作快速成型手术导板指导术中精确截骨,并评估术后效果。结果1.通过高颧骨患者的术前术后斜侧面照片的测量分析显示：平均颧突值术后有显著的降低并接近正常貌美组人群数值,而颧高值并无明显变化。颧骨降低术后患者容貌值有显著提高。2.通过计算机辅助技术对L型颧骨截骨降低术前后三维CT重建图像及二维断层影像进行测量分析发现：颧骨L型截骨降低术后颧骨颧弓复合体突度、宽度以及角度等参数都得到明显的改善,颧骨与颅颌面相关骨性比例变得更加协调。颧弓宽度从根部向前方变化量逐渐增大,于颧弓前2/3部分开始变得显著。3.通过数字化外科和快速成型技术辅助单侧L型颧骨截骨降低术矫正颧骨不对称畸形,患者双侧颧骨不对称均得到矫正,并未出现并发症。术后三维重建模型和术前设计模型配比和差值分析结果显示出微小的差异。结论1.本研究创新地提出了简单、直观的应用数字化照片测量评估颧部轮廓的分析方法。颧骨L型截骨降低术可以显著地降低颧突点突度,并不造成明显的颧突点下移,手术美学效果好。2.通过对高颧骨患者手术前后二维及三维CT测量研究发现：L型颧骨截骨降低术后颧骨颧弓复合体宽度、突度、以及角度等参数都得到明显地改善,颧骨与颅颌面相关骨性比例变得更加协调。颧骨L型截骨降低术最佳适应征为：颧骨体突出伴或不伴颧弓前部突出患者。3.应用数字化外科技术及快速成型技术辅助单侧颧骨L型截骨降低术矫正颧骨不对称畸形,可以进行术前设计和模拟截骨,设计最佳手术方案,制备快速成型手术导板指导术中精确截骨,可有效地提高手术精确性并减少风险。
[Abstract]:Objective 1. The most common medical image data of plastic surgery, digital photograph, were used to measure and analyze the profile of zygomatic region in patients with L-type zygomatic osteotomy before and after operation. Three-dimensional CT reconstruction images and two-dimensional CT tomography images were measured to explore and summarize L-type zygomatic osteotomy to reduce the changes of craniofacial bone structure. Digital surgical technique was used to improve the accuracy and safety of unilateral L-type osteotomy for correction of asymmetric malformation of zygomatic bone. Method 1. The digital photographs of subjects were collected, and the evaluation method of zygomatic contour was put forward, and the relative data of pre-and post-operative and normal persons with high zygomatic bone were measured, and the changes of zygomatic contour after L-type zygomatic osteotomy were evaluated objectively and quantitatively. The correlation principle of anthropometry was used to measure and analyze the preoperative and postoperative 3D CT reconstruction images and tomographic CT images of patients with high zygomatic bone, and to study the reduction of the width and protrusion of zygomatic bone before and after L-type zygomatic osteotomy. Angle and ratio of craniomaxillofacial bone parameters change. 3. The digital surgical technique was used to reconstruct the imaging data of bilateral zygomatic asymmetry patients. The individualized surgical design and simulation were carried out on the digital surgical platform, and the rapid prototyping guide plate was made to guide the accurate osteotomy during the operation. The effect of operation was evaluated. Result 1. The results showed that the mean zygomatic process value was significantly decreased after operation and was close to that in the normal group, but there was no significant change in the zygomatic height value in the patients with high zygomatic bone. The value of facial appearance in patients with lower zygomatic bone after operation was significantly increased by. 2. 2. Three-dimensional CT reconstruction images and two-dimensional tomographic images before and after L-shaped zygomatic osteotomy were measured and analyzed by computer-aided technique. The results showed that L-type zygomatic osteotomy reduced the degree of zygomatic arch complex after operation. The parameters such as width and angle were improved obviously, and the ratio of zygomatic bone and craniofacial bone became more harmonious. The width of zygomatic arch increased gradually from the root to the front, and began to become significant at the third third of the front of the zygomatic arch. Digital surgery and rapid prototyping were used to assist unilateral L-shaped zygomatic osteotomy to correct asymmetric malformation of zygomatic bone. The bilateral asymmetry of zygomatic bone was corrected without complication. The results of three-dimensional reconstruction model and pre-operative design model showed slight difference. Conclusion 1. In this study, a simple and intuitionistic analysis method of zygomatic profile was proposed. L-type zygomatic osteotomy can significantly reduce the zygomatic process point protrusion, and does not cause obvious zygomatic process point downward shift, the aesthetic effect of the operation is good. 2. Two-dimensional and three-dimensional CT measurements before and after surgery in patients with high zygomatic bone showed that the width, protuberance, and angle of zygomatic arch complex were significantly improved after surgery. The ratio of zygomatic bone to craniofacial bone became more harmonious. The best adaptation sign of L-type osteotomy was: zygomatic body protrusion with or without anterior zygomatic arch protrusion. Digital surgical technique and rapid prototyping technique were used to assist unilateral L-type osteotomy to correct asymmetric malformation of zygomatic bone, which could be used to design and simulate osteotomy before operation and to design the best operative scheme. The preparation of rapid prototyping guide plate can effectively improve the accuracy and reduce the risk of operative osteotomy.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R782.2

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