数字化技术辅助耳廓定位及特型支架设计在颅颌面不对称患者耳廓再造中的应用

发布时间：2018-10-18 14:43

【摘要】：目的：运用数字化技术针对颅面不对称患者优化耳廓再造的定位及特型耳支架设计,寻求一种可以提高术后对称效果的方法。对象及方法：1.对象在2014年9月-2015年3月入院进入我组治疗的合并颅颌面畸形的单侧小耳畸形患者中,符合入选条件的50例患者：男36例,女14例,年龄5岁-20岁,平均年龄8.28岁。分为研究组、对照组两组,每组25人。2.方法(1)应用三维摄影扫描技术对研究组患者行耳廓、颅面扫描,并以扫描数据建立耳廓、颅面部数字化模型,以数字化技术在该数字化模型上进行再造耳廓定位并获取耳支架形态参数及矫正参数。(2)应用螺旋CT扫描,对研究组患者行肋软骨扫描,并通过CT三维重建技术获得肋软骨数字化模型,并在数字化模型上测量肋软骨形态学参数估计肋软骨组织量。(3)根据上述耳廓定位信息、参数及肋软骨组织量,研究组行个性化耳支架的制备并行扩张法耳廓再造术,对照组常规手术。(4)对研究组及对照组术后一月进行随访,由术者、第三方整形医师、家属,第三方家属针对再造耳正面观、侧面观、后面观等视角对称性进行独立评分(其中第三方整形医师及第三方家属为盲评),以优、良、差表示,针对对称性优良率进行K(Kappa)检验,进行统计学分析。结果：1.三维摄影扫描建立的头颅及耳廓数字化模型形态清晰,逼真立体感强；2.数字化三维模型中健侧耳廓、颅面与患侧耳廓颅面完成镜像操作及交互对比定位后,健耳镜像与患侧颅面间存在间隙；3.数字化三维模型中通过软件操作获得双侧耳廓良好对称性后,可通过软件对定位信息进行标定。在数字化模型中测量出耳廓形态学参数及矫正参数,准确反映双耳基底面差异。4.术后一月随访结果示：术者、第三方整形医师、家属、第三方家属对研究组评分高于对照组,其中第三方整形医师、家属、第三方家属评分结果有显著性差异。结论：1.通过三维摄影扫描技术可以建立良好的耳廓、颅面数字化模型指导临床操作。2.通过对数字化模型进行分析可以获得再造耳廓定位信息,再造耳耳支架设计所需形态学参数及矫正参数。3.以上述定位信息及参数信息为指导对颅颌面不对称患者进行耳廓再造术,术后随访耳廓对称性效果较常规方法所得对称性效果好。
[Abstract]:Objective: to optimize the location of auricle reconstruction and the design of special ear stent for patients with craniofacial asymmetry by digital technique, and to find a method to improve the effect of postoperative symmetry. Object and method: 1. Participants were admitted to our group from September 2014 to March 2015 for unilateral microauricular malformation with craniomaxillofacial malformation. The 50 patients who met the criteria were 36 males and 14 females, aged from 5 to 20 years, with an average age of 8.28 years. Divided into study group, control group two groups, each group of 25 people. 2. Methods (1) the auricle and craniofacial images of the patients in the study group were scanned by three-dimensional radiography, and the digital models of auricle and craniofacial were established by scanning data. Digital technique was used to locate the reconstructed auricle and obtain the shape and correction parameters of the scaffold. (2) the patients in the study group were scanned by spiral CT scanning, and the patients in the study group were scanned with costal cartilage. The digital model of costal cartilage was obtained by CT 3D reconstruction technique, and the morphological parameters of costal cartilage were measured to estimate the amount of costal cartilage tissue. (3) according to the above auricle location information, the parameters and the amount of costal cartilage tissue were measured. The patients in the study group underwent auricle reconstruction with individualized auricular stent and dilated auricle reconstruction. (4) the patients in the study group and the control group were followed up for one month after operation, followed up by the operator, the third party plastic surgeon, the family members, the third party plastic surgeon, and the control group. The third party family evaluated the symmetry of the positive view, the side view and the back view of the reconstructed ear independently (including the third party plastic surgeon and the third party family member as the blind evaluation), expressed as excellent, good and bad, and carried out the K (Kappa) test on the symmetry excellent and good rate. Statistical analysis was carried out. The result is 1: 1. The digital model of skull and auricle established by three-dimensional photography is clear in shape and realistic in three-dimensional sense. 2. In the digitized 3D model, there is a gap between the healthy ear image and the affected craniofacial image after the mirror image operation and the interactive comparative positioning between the craniofacial and the cranial surface of the affected side. 3. The localization information can be calibrated by software after the good symmetry of the bilateral auricles is obtained by software operation in the digital 3D model. The morphological parameters and correction parameters of auricle were measured in the digital model. The results of follow-up for one month after operation showed that the score of the study group was higher than that of the control group, and the scores of the third party plastic surgeon, the family member and the third party family member were higher than those of the control group. Conclusion 1. A good auricle and craniofacial digital model can be established by three-dimensional photography to guide clinical operation. 2. Through the analysis of digital model, the location information of reconstructed auricle can be obtained, and the morphological parameters and correction parameters needed for the design of auricle scaffold can be obtained. Under the guidance of the above location information and parameter information, the effect of auricle reconstruction in patients with craniomaxillofacial asymmetry was better than that obtained by conventional methods.
【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】：2015
【分类号】：R622;TP391.7

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