计算机辅助下应用自体下颌骨外板治疗面斜裂的序列手术流程
发布时间:2018-10-09 10:08
【摘要】:中文摘要: 背景:面斜裂是累及面部旁中线结构的一种先天性颅面畸形。面斜裂的治疗包括骨和软组织的重建。应用计算机辅助设计的序列手术流程,包括下颌骨外板移植结合内眦韧带复位固定,在治疗面斜裂方面取得很好的临床效果。 方法:本研究包括我科从2004年1月到2013年12月收治的12位面斜裂患者,在我科接受了下颌骨外板自体骨移植以及内眦韧带复位固定。患者的平均年龄为18岁(范围,13到25岁),应用数字化3D外科技术辅助进行手术设计,应用自体下颌骨外板贴附植骨在骨缺损和骨凹陷部位,同期或再期行患侧内眦韧带的复位固定术,重建面部的对称性。对患者的临床记录、照片和放射检查资料进行了回顾性研究。 结果:所有的患者都获得了显著的治疗效果和较好的满意度。患者自我畸形程度的评分明显降低。患者自我评价畸形严重程度的10分简易量表得分在术后有显著降低(p0.001),术后6到12个月后也没有明显的差异(p=0.069)。内眦韧带的位置得到了改善(p<0.001),没有明显的复发(p=0.096)。下颌骨供区的恢复程度平均为(48.44±16.89)%(范围,11.03%到71.33%)。移植骨块被吸收体积为原移植骨块的28.67±14.39%(范围,12.58%to69.17%)。比较各移植部位的骨块吸收程度均没有统计学差异。在6例患者中出现非常轻微容易修复的并发症。 结论:这种序列手术方法对于面斜裂的治疗是有效的。术后取得了较好的患者满意度,也得到了面部对称性的改善。术后遗留的皮肤疤痕相对其他自体骨移植较少,而且术后骨块吸收程度也可以接受,下颌骨供区也有明显的恢复。计算机辅助分析和手术模拟设计面斜裂的治疗方案可以有效的描述颅面部骨骼畸形的特点,为手术重建提供有用的指导。
[Abstract]:Abstract: background: oblique facial fissure is a congenital craniofacial malformation involving the midline of parafafacial structure. The treatment of oblique facial fissure includes bone and soft tissue reconstruction. The sequence procedure of computer aided design, including mandibular external plate transplantation and medial canthus ligament reduction and fixation, has achieved good clinical results in the treatment of oblique facial fissure. Methods: this study included 12 patients with oblique facial fissure treated in our department from January 2004 to December 2013. We accepted autogenous bone transplantation of external plate of mandible and reduction and fixation of medial canthus ligament in our department. The average age of the patients was 18 years (ranging from 13 to 25 years). The surgical design was assisted by digital 3D surgical techniques. Autogenous mandibular plates were used to attach grafts to bone defects and depressions. The reconstruction of facial symmetry was performed at the same time or in another stage by the reduction and fixation of the medial canthus ligament on the affected side. The clinical records, photographs and radiographic data of the patients were retrospectively studied. Results: all patients received significant therapeutic effects and satisfactory results. The score of the degree of self-deformity was significantly decreased. The scores of 10 mini-scales for self-evaluation of deformity were significantly decreased after operation (p0.001), and there was no significant difference 6 to 12 months after operation (p0. 069). The location of the medial canthus ligament was improved (p < 0.001), and there was no obvious recurrence (p0. 096). The average recovery of mandibular donor area was (48.44 卤16.89)% (range from 11.03% to 71.33%). The absorbed volume of the graft was 28.67 卤14.39% of the original graft (range 12.58 to 69.17%). There was no significant difference in the degree of bone graft resorption among the grafts. In 6 patients, complications were very mild and easy to repair. Conclusion: this sequence procedure is effective for the treatment of oblique facial fissure. Good patient satisfaction and facial symmetry were achieved after operation. Compared with other autogenous bone grafts, the residual skin scars were less, and the degree of bone graft resorption was acceptable, and the mandibular donor region recovered obviously. Computer-aided analysis and surgical simulation can describe the characteristics of craniofacial bone deformities and provide useful guidance for surgical reconstruction.
【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】:2014
【分类号】:TP391.7;R782.2
本文编号:2258947
[Abstract]:Abstract: background: oblique facial fissure is a congenital craniofacial malformation involving the midline of parafafacial structure. The treatment of oblique facial fissure includes bone and soft tissue reconstruction. The sequence procedure of computer aided design, including mandibular external plate transplantation and medial canthus ligament reduction and fixation, has achieved good clinical results in the treatment of oblique facial fissure. Methods: this study included 12 patients with oblique facial fissure treated in our department from January 2004 to December 2013. We accepted autogenous bone transplantation of external plate of mandible and reduction and fixation of medial canthus ligament in our department. The average age of the patients was 18 years (ranging from 13 to 25 years). The surgical design was assisted by digital 3D surgical techniques. Autogenous mandibular plates were used to attach grafts to bone defects and depressions. The reconstruction of facial symmetry was performed at the same time or in another stage by the reduction and fixation of the medial canthus ligament on the affected side. The clinical records, photographs and radiographic data of the patients were retrospectively studied. Results: all patients received significant therapeutic effects and satisfactory results. The score of the degree of self-deformity was significantly decreased. The scores of 10 mini-scales for self-evaluation of deformity were significantly decreased after operation (p0.001), and there was no significant difference 6 to 12 months after operation (p0. 069). The location of the medial canthus ligament was improved (p < 0.001), and there was no obvious recurrence (p0. 096). The average recovery of mandibular donor area was (48.44 卤16.89)% (range from 11.03% to 71.33%). The absorbed volume of the graft was 28.67 卤14.39% of the original graft (range 12.58 to 69.17%). There was no significant difference in the degree of bone graft resorption among the grafts. In 6 patients, complications were very mild and easy to repair. Conclusion: this sequence procedure is effective for the treatment of oblique facial fissure. Good patient satisfaction and facial symmetry were achieved after operation. Compared with other autogenous bone grafts, the residual skin scars were less, and the degree of bone graft resorption was acceptable, and the mandibular donor region recovered obviously. Computer-aided analysis and surgical simulation can describe the characteristics of craniofacial bone deformities and provide useful guidance for surgical reconstruction.
【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】:2014
【分类号】:TP391.7;R782.2
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