数字化截骨导板在下颌角截骨术中的应用研究
发布时间：2019-05-06 09:53
【摘要】：目的：下颌角弧形截骨术是颌面外科常见的美容手术之一,目前术者对双侧截骨线的设计大多是通过术前阅片(X光片+CT)以及计算机软件测量设计并进行手术效果模拟来实现的,但怎样将术前设计的手术方案及各个测量数据精确地复制到术中患者的下颌骨上一直是一个难题。再加上本手术操作视野狭小,术者很难对术区获得有效的三维视觉,进而对截骨线的设计单凭经验而有失精确性。本研究将借助于计算机软件三维设计、3D打印等数字化技术,术前在计算机三维模型上精确设计截骨线,并通过计算机软件沿截骨线设计制作能够与下颌角区骨质的三维形态完全匹配的数字化截骨导板,再将这些导板数据通过3D打印技术打印出实体导板,术中置入术区指导截骨,从而提高手术的精确性和对称性,缩短手术时间,并降低手术并发症的发生率 方法：第一部分确定导板置入术区的可行性：首先将患者的CT数据转化为STL格式文件,并导入3D打印机(Z-printer350)打印下颌骨3D模型。再将患者的CT资料转入ProPlan软件中,在计算机中重建下颌骨三维模型,在虚拟三维模型上设计截骨线,并对各个标志点进行测量,再根据测量的数据将截骨线标记到打印的下颌骨3D模型上,将自凝树脂沿标记的截骨线捏合于模型上制作截骨导板。定型后取下,术中2%碘酒浸泡消毒后置入术区。本部分研究将确定不同类型的下颌角所对应的截骨导板的不同形态,并验证不同导板置入术区的可行性。第二部分通过ProPlan软件在虚拟三维模型上设计截骨线,再将截骨数据以STL文件形式导入GeoMagic软件,设计数字化截骨导板,最后以通过FDA认证的聚乳酸(PLA)材料打印截骨导板,术中植入术区完成临床应用。 结果：针对不同类型的下颌角肥大患者设计不同的截骨方式,再据此确定不同类型的个性化截骨导板,导板形态适合置入术区。导板能够与术区骨质紧密贴合,稳定性好,截除的下颌角与截骨导板匹配度高。所有患者(第一部分10例,第二部分5例)术后效果均与术前设计一致,术中未出现骨折、大出血、感染等并发症,术后测量双侧下颌骨对称性良好。 结论：本研究通过数字化截骨导板将术前的设计数据准确的复制到术区骨骼,术者在导板的指引下能够准确的完成截骨,大大的提高了手术的精确性和对称性,实现了下颌角截骨手术从经验论到数字化的转化,并简化了下颌角截骨术式,制定的标准化治疗模式对临床工作具有重大的指导意义。
[Abstract]:Objective: mandibular angle arc osteotomy is one of the common cosmetic operations in maxillofacial surgery. At present, the design of bilateral osteotomy line is mostly achieved by preoperative X-ray reading (CT) and computer software measurement design and surgical effect simulation. However, it has been a difficult problem how to accurately copy the preoperative surgical scheme and the measured data to the mandible of the patients during the operation. In addition, it is difficult for the operator to obtain an effective 3-D vision of the operation area, and then the design of the osteotomy line is less accurate based on the experience. In this study, the computer software 3D design, 3D printing and other digital technology will be used to accurately design the osteotomy line on the computer three-dimensional model before the operation. Through the computer software along the osteotomy line, a digital osteotomy guide plate which can match the three-dimensional shape of the mandible angle bone is designed and made. Then the data of the guide plate is printed out by the 3D printing technology, and the osteotomy is guided in the operation area. In order to improve the accuracy and symmetry of the operation, shorten the operation time, and reduce the incidence of complications methods: part one to determine the feasibility of inserting the guide plate into the operation area: first, convert the patient's CT data into the STL format file. And import a 3D printer (Z-printer350) to print a 3D model of the mandible. Then the CT data of the patients were transferred into the ProPlan software to reconstruct the three-dimensional model of the mandible in the computer, design the osteotomy line on the virtual three-dimensional model, and measure the mark points. According to the measured data, the osteotomy line was labeled on the printed 3D model of mandible, and the autocoagulation resin was kneaded along the labeled osteotomy line to make the osteotomy guide plate. After shaping, 2% iodine wine was soaked and sterilized and placed into the operation area. This study will determine the different shape of osteotomy guide plate corresponding to different mandibular angle and verify the feasibility of inserting different guide plate into the operation area. The second part designs the osteotomy line on the virtual three-dimensional model by the ProPlan software, then imports the osteotomy data into the GeoMagic software in the form of STL file, designs the digital osteotomy guide board, and finally prints the osteotomy guide board with the FDA-certified polylactic acid (PLA) material. The clinical application of intraoperative implantation was completed. Results: different osteotomy methods were designed for patients with different types of mandibular angle hypertrophy, and then different types of individualized osteotomy guide plates were determined. The shape of the guide plates was suitable for insertion into the operation area. The guide plate can fit closely with the bone of the operation area, and has good stability, and the mandibular angle after removal is highly matched with the osteotomy guide plate. All the patients (10 cases in the first part and 5 cases in the second part) had the same postoperative effect as the preoperative design. There were no complications such as fracture, massive hemorrhage and infection during the operation. The bilateral mandible symmetry was well measured after the operation. Conclusion: the digital osteotomy guide plate can accurately copy the preoperative design data to the bone of the operation area. Under the guidance of the guide plate, the surgeon can accurately complete the osteotomy, which greatly improves the accuracy and symmetry of the operation. The transformation from experience to digitalization of mandibular angle osteotomy is realized, and the operation style of mandibular angle osteotomy is simplified. The standardized treatment mode is of great guiding significance to clinical work.
【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】：2014
【分类号】：R782
本文编号：2470086
[Abstract]:Objective: mandibular angle arc osteotomy is one of the common cosmetic operations in maxillofacial surgery. At present, the design of bilateral osteotomy line is mostly achieved by preoperative X-ray reading (CT) and computer software measurement design and surgical effect simulation. However, it has been a difficult problem how to accurately copy the preoperative surgical scheme and the measured data to the mandible of the patients during the operation. In addition, it is difficult for the operator to obtain an effective 3-D vision of the operation area, and then the design of the osteotomy line is less accurate based on the experience. In this study, the computer software 3D design, 3D printing and other digital technology will be used to accurately design the osteotomy line on the computer three-dimensional model before the operation. Through the computer software along the osteotomy line, a digital osteotomy guide plate which can match the three-dimensional shape of the mandible angle bone is designed and made. Then the data of the guide plate is printed out by the 3D printing technology, and the osteotomy is guided in the operation area. In order to improve the accuracy and symmetry of the operation, shorten the operation time, and reduce the incidence of complications methods: part one to determine the feasibility of inserting the guide plate into the operation area: first, convert the patient's CT data into the STL format file. And import a 3D printer (Z-printer350) to print a 3D model of the mandible. Then the CT data of the patients were transferred into the ProPlan software to reconstruct the three-dimensional model of the mandible in the computer, design the osteotomy line on the virtual three-dimensional model, and measure the mark points. According to the measured data, the osteotomy line was labeled on the printed 3D model of mandible, and the autocoagulation resin was kneaded along the labeled osteotomy line to make the osteotomy guide plate. After shaping, 2% iodine wine was soaked and sterilized and placed into the operation area. This study will determine the different shape of osteotomy guide plate corresponding to different mandibular angle and verify the feasibility of inserting different guide plate into the operation area. The second part designs the osteotomy line on the virtual three-dimensional model by the ProPlan software, then imports the osteotomy data into the GeoMagic software in the form of STL file, designs the digital osteotomy guide board, and finally prints the osteotomy guide board with the FDA-certified polylactic acid (PLA) material. The clinical application of intraoperative implantation was completed. Results: different osteotomy methods were designed for patients with different types of mandibular angle hypertrophy, and then different types of individualized osteotomy guide plates were determined. The shape of the guide plates was suitable for insertion into the operation area. The guide plate can fit closely with the bone of the operation area, and has good stability, and the mandibular angle after removal is highly matched with the osteotomy guide plate. All the patients (10 cases in the first part and 5 cases in the second part) had the same postoperative effect as the preoperative design. There were no complications such as fracture, massive hemorrhage and infection during the operation. The bilateral mandible symmetry was well measured after the operation. Conclusion: the digital osteotomy guide plate can accurately copy the preoperative design data to the bone of the operation area. Under the guidance of the guide plate, the surgeon can accurately complete the osteotomy, which greatly improves the accuracy and symmetry of the operation. The transformation from experience to digitalization of mandibular angle osteotomy is realized, and the operation style of mandibular angle osteotomy is simplified. The standardized treatment mode is of great guiding significance to clinical work.
【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】：2014
【分类号】：R782
【参考文献】
相关期刊论文 前9条
1 焦培峰;齐向东;祁佐良;方建蔺;陆云涛;钟世镇;原林;;下颌角的CT三维重建模拟整形术[J];解剖学报;2006年05期
2 杨斌,张涤生,黄洪章,冯胜之,穆雄铮,韦敏,龙公;颅面外科三维诊断分析和手术设计系统的建立[J];口腔颌面外科杂志;2000年04期
3 王雪;李金华;;自凝临时冠材料过敏1例[J];口腔医学;2006年03期
4 孙坚,孙弘;外耳后进路手术治疗下颌角与咬肌肥大[J];中国美容医学;2001年01期
5 赵继志;刘文阁;戴晴;杨佩瑛;;A型肉毒毒素治疗良性咬肌肥大远期疗效观察[J];中国美容医学;2007年07期
6 文辉才;柳大烈;巫国辉;陈兵;单磊;王竞鹏;黄文博;;口内入路应用直角钻打孔法截骨和摆动锯截骨矫治下颌角肥大的比较研究[J];中国美容医学;2008年10期
7 陈志鹏;陈滔;丁祖烈;严巧玲;;使用X线片模板定位下颌角截骨术[J];中国美容医学;2010年05期
8 邱爽;陈莹;归来;王梦;牛峰;俞冰;刘剑锋;刘伟;张岩];;患者参与的计算机辅助设计在个性化下颌角弧形截骨术中的应用[J];中国美容医学;2011年07期
9 张德香;唐勇;;自凝塑料义齿致低热1例报告[J];吉林医学;2005年12期
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