数字模拟结合三维快速成型技术在面部轮廓整形中的应用研究

发布时间：2018-04-30 16:45

本文选题：数字模拟 + 三维打印　；参考：《南方医科大学》2017年硕士论文

【摘要】：背景:人的面部外观在个人的心目中占据着重要地位,对个人发展、人际交往等有着重要的影响。随着时代的发展,颜面部整形逐渐为越来越多的人所熟悉和接受,其中,面部轮廓整形较为常见。在整形外科领域,面部轮廓整形是一个相当复杂的过程,其通过改变面部局部组织含量的多少来调整面部外形;然而,难以确定其适当的变化量。同时,它要求轮廓的改变符合外科医生的设想和患者的期望。历来,术者主要通过个人经验来评估可能产生的术后效果,缺乏客观有效的工具来指导手术。这可能导致术后效果的不确定性。不符合求美者的术前期望。随着影像学技术的发展,医生从单纯通过X光片等图像获取患者的相关信息,到应用计算机分析处理二维图像辅助术前设计,再到应用三维重建技术联合计算机模拟辅助术前术后的评估及手术规划,应用这些方式均可提供有效客观依据辅助手术进行,完善手术计划,提高手术预后效果。然而,单一应用三维数字模拟不能满足患者复杂的手术需求,并且三维数字模拟局限于平面,缺乏立体直观感。因此,这项研究是为了探讨并评估在面部外形轮廓整形中联合应用数字模拟和三维快速成型技术指导手术进行的准确性和有效性,以获得更好的预期结果,提高患者满意度。患者和方法:招募对自身面部轮廓外形不满意的患者,分为正面轮廓和侧面轮廓整形。我们选择鼻根地平、颏部短小、颧骨突出、下颌角肥大等患者进行面部轮廓整形的研究。分为实验组与对照组,实验组为采用数字化模拟与快速成型技术联合应用辅助手术,对照组为常规手术流程。具体实验方法为:首先根据患者需求选择应用三维表面成像(侧面轮廓)或计算机断层成像(正面轮廓)重建个体三维数字化模型。然后对数字化三维模型进行全面的研究,测量和分析,进而做出术前诊断。基于三维重建,应用数字模拟系统对骨和软组织进行切割,旋转和平移操作等操作模拟手术的进行,进而得出模拟的术后结果。与患者沟通协商,确认最佳的模拟效果。基于数字模拟效果,联合应用三维快速成型技术定制个性化的手术模板用以熟悉并指导手术的操作。术后,通过头颅测量分析、医生的相似性评价、患者的满意度评分来主客观评价数字模拟的准确性与有效性。结果:根据专业外科医生的评级,三维表面成像和CT三维成像两套三维成像模拟系统的数字模拟的平均总精度分别为87.5%,83.4%。满意度方面,实验组中患者的平均满意度均在3.4以上,相对于对照组,存在统计学差异。头颅测量分析显示,术前模拟与实际术后结果之间的平均差异限于2.17 mm,两个数字模拟系统的模拟改变量与实际改变之间的差异小,两者较为一致,均未见明显统计学差异。两个数字化模拟系统术前模拟与术后差异之间的比较亦未见明显差异。结论:数字模拟是一个精确有效的方法,用于面部轮廓整形中,可以获得有效和可靠的术前预测结果。联合应用两种模拟系统,有效针对面部外部软组织轮廓和内部骨组织,可良好应对面部轮廓整形的复杂需求。辅助三维打印个性化定制手术模板能模拟手术操作,直观指导手术的进行,获得更好的预期结果。同时,与患者沟通确定手术方案,建立良好的医患教育,提高患者术后满意度。
[Abstract]:Background: human facial appearance occupies an important position in the mind of individuals, and has an important influence on personal development and interpersonal communication. With the development of the times, facial shaping is gradually familiar and accepted by more and more people. Among them, facial contour shaping is more common. In the field of plastic surgery, facial contour shaping is a equivalent. A complex process that adjusts the facial contour by changing the amount of local tissue in the face; however, it is difficult to determine the appropriate amount of change. At the same time, it requires that the changes of the contour conform to the surgeon's imagination and the expectation of the patient. Tools are used to guide the operation. This may lead to uncertainty in postoperative effects. It does not conform to the expectations of the beauty beg. With the development of imaging techniques, doctors obtain information from the patients only through images such as X ray, to the application of computer analysis to process two-dimensional image auxiliary design, and then to the application of three-dimensional reconstruction techniques. The application of these methods can provide effective and objective basis for the operation, improve the operation plan, and improve the outcome of the operation. However, the single application of 3D digital simulation can not meet the patient's complicated operation needs, and the three-dimensional digital simulation is limited to the plane and lacks the stereoscopic vision. Therefore, this study is designed to explore and evaluate the accuracy and effectiveness of the combined application of digital simulation and three-dimensional rapid prototyping in facial contour shaping in order to obtain better expected results and improve patient satisfaction. Patients and methods: recruit patients with discontentions of their facial contour to be divided into The frontal and lateral contour shaping. We chose the nasal root flat, the chin short, the zygomatic protrusion, the mandibular angle hypertrophy and other patients for facial contour shaping. The experimental group and the control group were divided into the experimental group and the control group. The control group was the routine procedure. The specific experimental method was used in the control group. Firstly, the three-dimensional digital model of the individual is reconstructed by using the three-dimensional surface imaging (side contour) or computed tomography (frontal contour). Then the digital 3D model is studied, measured and analyzed, and then the preoperative diagnosis is made. Based on the three-dimensional reconstruction, the digital simulation system is applied to the bone and soft tissue. Perform a simulated operation, such as cutting, rotation, and translation, and then getting the simulated results. Communicate with the patient to confirm the best simulation results. Based on the numerical simulation effect, the combined application of the three-dimensional rapid prototyping technology to customize the personalized surgical templates is used to familiarize and guide the operation. Quantitative analysis, doctor's similarity evaluation, patient satisfaction score for the accuracy and effectiveness of the subjective and objective evaluation digital simulation. Results: the average total accuracy of the digital simulation of two three-dimensional imaging simulation systems based on the professional surgeon's rating, the three dimensional surface imaging and the CT three-dimensional imaging system is 87.5%, the 83.4%. satisfaction aspect, the experimental group The average degree of satisfaction of the patients was above 3.4, compared with the control group, there was a statistical difference. The average difference between the pre operation simulation and the actual postoperative results was limited to 2.17 mm, and the difference between the analog changes of the two digital simulation systems and the actual changes was small. There is no significant difference between the preoperative simulation and the postoperative differences between the two digital simulation systems. Conclusion: digital simulation is an accurate and effective method for facial contour shaping, which can obtain effective and reliable preoperative prediction results. The combined application of two analog systems is effective against the external soft tissue profile and internal face of the face. Bone tissue can well respond to the complex needs of facial contour shaping. Assisted three-dimensional printing of personalized customized surgical templates can simulate surgical operations, direct the operation and obtain better expected results. At the same time, communicate with the patients to determine the operation plan, establish a good medical education, and improve the patient's postoperative satisfaction.

【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R622

【参考文献】