基于数字化技术的改良牵引成骨术矫治半侧颜面短小畸形及疗效评估

发布时间：2018-08-26 19:34

【摘要】：目的1建立适合半侧颜面短小畸形骨组织与软组织三维测量方法,利用三维CT影像学数据及面部三维扫描数据,对其颅面部骨组织及软组织畸形进行定量化评估,分析其面部不对称畸形的形态学特点。2探讨在数字化技术的辅助下,应用联合下颌升支矢状劈开截骨术的改良式牵引成骨技术,治疗半侧颜面短小畸形的方法及临床效果。3利用创建的硬软组织三维测量方法,对半侧颜面短小畸形患者改良式牵引成骨术前后的软硬组织变化情况进行测量分析,定量化评估手术效果。方法选择2013年6月至2015年10月间于中国医学科学院整形外科医院颌面整形外科中心进行治疗的半侧颜面短小畸形患者10例。1利用半侧颜面短小畸形患者的CT数据及面部三维扫描数据,分别在MIMCS软件中建立骨组织及软组织三维测量坐标系,标记各个解剖标志点,进行健侧患侧精确的定量化分析,了解其面部不对称畸形的形态特征,并利用此方法进行术前评估。2术前将CT数据三维重建出骨组织模型,标记出下牙槽神经管的走向及牙胚的位置,并以此为依据精确设计手术截骨方案,根据健侧患侧下颌骨不对称情况设计牵引延长的距离和方向,用于指导手术。术中使用结合下颌升支矢装劈开截骨术的改良式牵引成骨术进行截骨,以保护患者下牙槽神经、血管及牙胚,进一步提升手术安全性及效果。术后行快速牵引,延长短小的下颌骨,改善面部不对称畸形。3利用我们建立的三维测量方法,对半侧颜面短小畸形患者术前术后的三维CT及面部扫描数据进行对比分析,计算各标志点的变化情况,并计算下颌升支高度等重要线距的变化情况,以定量化分析改良式牵引成骨术对半侧颜面短小畸形骨组织及软组织不对称的改善情况。结果1建立出三维测量方法,并对10例患者进行面部软组织畸形分析,初步探讨半侧颜面短小畸形软组织畸形的形态学特征,面部软组织畸形是三维方向的不对称畸形,多个轴向均存在不对称。上面部的软组织结构不对称畸形较轻,下面部的软组织不对称畸形较重,中面部接近中线的部位畸形程度较轻。2利用基于数字化技术的改良式牵引成骨术矫治10例半侧颜面短小畸形患者,未发生严重并发症,有效保护了重要血管、神经及牙胚结构,术后面不对称性获得了明显改善,咬合平面趋于水平,效果满意。3术后患侧下颌升支长度由35.9±3.85mm延长至44.85±5.05mm,厚度由8.29±1.OOmm增加至10.08+1.64mm,双侧下颌升支不对称率由30.30%±4.80%降低至13.27%±5.60%,颏下点至面中线的距离由13.19±3.52mm降至5.61±2.67mm,患侧面部口角至外眦间距离由62.93±5.61mm增加至65.92±5.84mm,患侧口角至耳屏间距离由77.58±9.34mm增加至82.224±10.71mm,结果具有统计学意义。面部骨组织及软组织的对称性获得了明显改善。结论1三维测量方法准确可靠,可以用于半侧颜面短小畸形对称性的分析及手术方案的制定,初步探讨了软组织不对称畸形的三维测量方法,同时适用于其他颅颌面畸形和相关美学研究,值得进一步探讨。2应用下颌升支矢状劈开截骨行牵引成骨技术,增加了骨接触面积,能加快牵引速率,缩短疗程,提高手术安全性,并发症少,能有效矫治半侧颜面短小畸形的颌骨不对称。3应用三维测量方法对改良式牵引成骨术后效果进行定量化评价,证实其治疗效果明确,可明显改善骨组织及软组织的不对称畸形,结果真实可靠。利用三维测量方法可以对半侧颜面短小畸形进行疗效评估,同时适用于其他畸形的疗效分析研究,适用性广,可以临床推广使用。
[Abstract]:Objective 1. To establish a three-dimensional measurement method for the bone and soft tissue of hemifacial micromalformation, and to quantitatively evaluate the skull and soft tissue deformities of hemifacial micromalformation by using three-dimensional CT imaging data and facial three-dimensional scanning data, and to analyze the morphological characteristics of facial asymmetric deformities. 2. To explore the application of digital technology. Methods and clinical effects of modified distraction osteogenesis combined with sagittal ramus osteotomy in the treatment of hemifacial microdeformity. 3 The changes of soft and hard tissues in hemifacial microdeformity patients before and after modified distraction osteogenesis were measured and analyzed by using the established three-dimensional measurement method of hard and soft tissue. Methods From June 2013 to October 2015, 10 patients with hemifacial microdeformity were selected from the Center of Maxillofacial Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences. Dimensional coordinate system was used to mark the anatomical landmarks, and quantitative analysis was performed on the affected side of the healthy side to understand the morphological characteristics of facial asymmetry deformity. 2 The bone tissue model was reconstructed from CT data before operation, and the orientation of the inferior alveolar canal and the position of the tooth germ were marked. The modified distraction osteogenesis combined with sagittal split ramus osteotomy was used to protect the inferior alveolar nerve, blood vessel and tooth germ, and to further enhance the safety and safety of the operation. Results. Rapid traction was used to lengthen the short mandible and improve the facial asymmetry. 3 The three-dimensional CT and facial scan data of the patients with hemifacial microdeformity were compared and analyzed by using the three-dimensional measurement method established by us. The changes of each landmark were calculated, and the height of mandibular ramus and other important line spacing were calculated. Results 1 A three-dimensional measurement method was established and 10 cases of facial soft tissue deformities were analyzed. The morphological characteristics, facial soft tissue deformities and soft tissue deformities of hemifacial short deformities were preliminarily discussed. Deformity is a three-dimensional asymmetric deformity with asymmetry in many axes. Soft tissue structural asymmetry in the upper part is lighter, soft tissue asymmetry in the lower part is heavier, and deformity in the middle face is lighter. 2 Modified traction osteogenesis based on digital technology was used to correct 10 cases of hemifacial short deformity. No serious complications occurred in the patients with M-shaped mandibular fracture. The facial asymmetry was significantly improved and the occlusal plane was level. The length of the affected mandibular ramus was increased from 35.9 (+ 3.85) mm to 44.85 (+ 5.05) mm. The thickness of the ramus increased from 8.29 (+ 1.OOmm) to 10.08 (+ 1.64) mm. The symmetry rate was reduced from 30.30%+4.80% to 13.27%+5.60%, the distance from the submental point to the midline of the face was reduced from 13.19%+3.52 mm to 5.61%+2.67 mm, the distance from the angle of mouth to the epicanthus was increased from 62.93%+5.61 mm to 65.92%+5.84 mm, and the distance from the angle of mouth to the tragus was increased from 77.58+9.34 mm to 82.224+10.71 mm in the facial bone group. The symmetry of tissue and soft tissue was improved obviously. Conclusion 1 The three-dimensional measurement method is accurate and reliable, and can be used to analyze the symmetry of hemifacial micromalformation and to make the operation plan. The three-dimensional measurement method of soft tissue asymmetry is preliminarily discussed. It is also suitable for other craniomaxillofacial deformities and related aesthetic research. Step 2. Sagittal split ramus osteotomy for distraction osteogenesis can increase the area of bone contact, speed up the distraction rate, shorten the course of treatment, improve the safety of operation, reduce complications, and effectively correct the jaw asymmetry of hemifacial short deformity. 3. Quantitative evaluation of the effect of modified distraction osteogenesis by three-dimensional measurement method The results showed that the treatment effect was definite, and the asymmetric deformity of bone and soft tissue could be improved obviously. The three-dimensional measurement method could be used to evaluate the curative effect of hemifacial microdeformity, and it was also suitable for the analysis of the curative effect of other deformities.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R782

【相似文献】