数字化外科和牵引成骨技术治疗半侧颜面短小畸形的临床研究
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摘要
研究目的
1建立适合半侧颜面短小畸形患者的三维CT影像学模型的三维坐标系,进行面部畸形的测量、分析,和牵引成骨的术前设计。
2利用快速成型技术设计手术导板,精确引导半侧颜面短小畸形患者下领骨截骨以后牵引器置入手术。
3对半侧颜面短小畸形患者下颌骨牵引前后三维CT影像学资料数据进行测量和统计学分析,评估手术效果,改进手术方式,寻找最佳手术时机。
研究对象及方法
研究对象：2009年8月～2011年6月在中国医学科学院整形外科医院颌面整形外科中心就诊的半侧颜面短小畸形患者12例。
研究方法：
1将半侧颜面短小畸形患者的三维CT模型数据导入医用软件中,计算出镜像模型,将两数据同时输入工业设计软件中求导最佳拟合平面,设立为三维模型的正中矢状面,在此基础上重设三维坐标系。标记各解剖标记点,记录三维坐标,进行精确的测量分析,了解面部不对称的构成和程度。根据测量的结果精确设计牵引器植入的位置和方向。
2将半侧颜面短小畸形患者的三维CT模型数据导入医用软件中,分体重建下齿槽血管神经束、牙胚等一一标记于下颌骨外板,再将所有数据导入工业设计软件,精确设计截骨方案,利用RP技术设计手术导板,在术中以手术导板引导手术操作与术前设计思想的无缝衔接,简化手术难度,降低意外损伤风险,缩短手术时间,提高手术效果。
3将半侧颜面短小畸形患者术前的三维CT模型数据导入工业软件中,重设三维坐标系,导入术后的三维模型数据并与术前数据精确匹配,使之统一于同一三维坐标系。测量各解剖标志点的术前术后三维坐标值,并计算各骨性标志点、线距、空间角度和各解剖平面的空间改变。
结果
112例半侧颜面短小畸形患者经过重设三维坐标系,术前精确测量分析和设计后,顺利行下颌骨牵引延长手术。
2通过使用RP技术制造出数字化颌骨手术导板,将手术操作与术前设计精确拟合,全面实现手术设计方案,提高了手术的精确性和安全性。其中2例患者升支严重发育不良,由于精确的方案及手术导板的应用,避免了下颌升支重建手术,牵引延长顺利,效果良好。
3测量6例半侧颜面短小畸形患者术前和术后半年的三维CT数据,并进行了部分数据的统计学分析。测量结果证实数字化技术指导下的颌骨牵引手术效果满意。数据分析证实替牙期的儿童患者上颌骨和颧骨存在着很大的生长潜力,这一阶段手术可以有效减少手术次数和降低治疗的复杂程度。
结论
本实验运用数字化技术进行半侧颜面短小畸形的术前测量和精确的术前设计,设置最佳截骨手术方案；利用RP技术制作手术导板,引导手术过程,保证手术操作与术前设计思想的无缝衔接,提高了手术精确度,减少了手术操作难度；本研究还测量了6例患者的术前和术后半年的CT数据,并进行了部分数据的统计学分析,初步证实替牙期为半侧颜面短小畸形患者的最佳手术时机。
Objective
1Set up three-dimensional coordinate system of hemifacial microsomia (HFM)patients with three-dimensional CT (3DCT)imaging model. Analyze and measure the deformities of facial asymmetry.Designing preoperative scheme of distraction osteogenesis.
2Use rapid prototyping technique designs operative guide,accurately guiding mandiblular distractor implantation of hemifacial microsomia patients.
3Measure and statistically analyze the three-dimensional CT data of hemifacial microsomia before mandibular distractor implantation and after distractor removed,assessment the results of operations, improved surgical approach.
Study object and Methods
Study object12HFM patients treated in Plastic Surgery Hospital,Chinese Academy of Medical Sciences Centre, Maxillofacial Plastic Surgery from August2009to June2011were selected in the study.
Methods
1Input HFM patient's three-dimensional CT model data to medical software, calculating the mirro model data, and then input the two model data into industrial design software,looking for the best fitting plane,defining which as the symmytrical plane.Set the symmetrical plane as the median sagittal plane, then reset the three-dimensional coordinate system. Mark the anatomical landmarks,which should be accurate measured and analyzed in order to decide asymmetrical composition. Accurately design the position and orientation of distractor follow the results of measurement and analysis.
2Input patient's three-dimensional CT model data to medical software.Reconstruct the inferior alveolar neurovascular bundle, tooth etc, and then mark them at the outer cortex of mandible.Input all the data into industrial design software, and accurately design the osteotomy scheme.Desiged surgical guide using RP technology, guiding accurate designed osteotomy surgery. Unite preoperative design ideas and surgical procedures,simplifying surgical difficulty..reducing the risk of accidental injuries, reducing operation time and improving surgical results.
3Input patient's three-dimensional CT model data to industrial design software, and reset the three-dimensional coordinate system. Import postoperative three-dimensional CT model data,exact matching the preoperative data in order to unite them in the same three-dimensional coordinate system.Measure three-dimensional coordinate values of anatomical landmarks before and after the distraction osteogenisis, and calculate coordinates changes of skull anatomical landmarks, length, angle and anatomical plane.
Results
1After three-dimensional coordinate system was resetted, after accurate measured、analyzed and designed data of preoperation,12cases of hemifacial microsomia patients successfully completed mandibular distraction osteogenesis.
2Through using RP technique to produce digital guide of mandibular osteogenesis, surgical operation and preoperative design was well fitted. We realized the surgical design procedure perfectly, improving surgical precision and security.2patients had severe dysplasia on mandibular ramus, by accurate preoperation design and using surgical guide, had avoided the mandibular ramus reconstruction surgery, and the distraction process went smoothly.
3We measured6cases of hemifacial microsomia preoperation and postoperation three-dimensional CT data, and conducted a statistical analysis of some data. Measurement results confirmed that under the guidance of digital technology,mandibular distraction osteogenesis results were satisfactory. Data analysis confirmed that children in mixed dentition period have great growth potential on maxilla and zygoma.Distracition osteogenesis in this period can effectively reduce the operation times and the complexity of the surgery.
Conclusion
In this experiment we used digital surgery techniques for treatment of hemifacial microsomia patients.By preoperative measurement and analysis, dedign the best surgery program, and using RP technique to produce digital guide of mandibular osteogenesis, surgical operation and preoperative design was well fitted, we realized the surgical design procedure perfectly, improving surgical precision and security. We also measured6patients with preoperative and postoperative three-dimensional CT data, confirmed that children in mixed dentition period have great growth potential on maxilla and zygoma.Distracition osteogenesis in this period can effectively reduce the operation times and the complexity of the surgery. Mixed dentition period is the best timing of mandibular distraction osteogenesis.
1建立适合半侧颜面短小畸形患者的三维CT影像学模型的三维坐标系,进行面部畸形的测量、分析,和牵引成骨的术前设计。
2利用快速成型技术设计手术导板,精确引导半侧颜面短小畸形患者下领骨截骨以后牵引器置入手术。
3对半侧颜面短小畸形患者下颌骨牵引前后三维CT影像学资料数据进行测量和统计学分析,评估手术效果,改进手术方式,寻找最佳手术时机。
研究对象及方法
研究对象：2009年8月～2011年6月在中国医学科学院整形外科医院颌面整形外科中心就诊的半侧颜面短小畸形患者12例。
研究方法：
1将半侧颜面短小畸形患者的三维CT模型数据导入医用软件中,计算出镜像模型,将两数据同时输入工业设计软件中求导最佳拟合平面,设立为三维模型的正中矢状面,在此基础上重设三维坐标系。标记各解剖标记点,记录三维坐标,进行精确的测量分析,了解面部不对称的构成和程度。根据测量的结果精确设计牵引器植入的位置和方向。
2将半侧颜面短小畸形患者的三维CT模型数据导入医用软件中,分体重建下齿槽血管神经束、牙胚等一一标记于下颌骨外板,再将所有数据导入工业设计软件,精确设计截骨方案,利用RP技术设计手术导板,在术中以手术导板引导手术操作与术前设计思想的无缝衔接,简化手术难度,降低意外损伤风险,缩短手术时间,提高手术效果。
3将半侧颜面短小畸形患者术前的三维CT模型数据导入工业软件中,重设三维坐标系,导入术后的三维模型数据并与术前数据精确匹配,使之统一于同一三维坐标系。测量各解剖标志点的术前术后三维坐标值,并计算各骨性标志点、线距、空间角度和各解剖平面的空间改变。
结果
112例半侧颜面短小畸形患者经过重设三维坐标系,术前精确测量分析和设计后,顺利行下颌骨牵引延长手术。
2通过使用RP技术制造出数字化颌骨手术导板,将手术操作与术前设计精确拟合,全面实现手术设计方案,提高了手术的精确性和安全性。其中2例患者升支严重发育不良,由于精确的方案及手术导板的应用,避免了下颌升支重建手术,牵引延长顺利,效果良好。
3测量6例半侧颜面短小畸形患者术前和术后半年的三维CT数据,并进行了部分数据的统计学分析。测量结果证实数字化技术指导下的颌骨牵引手术效果满意。数据分析证实替牙期的儿童患者上颌骨和颧骨存在着很大的生长潜力,这一阶段手术可以有效减少手术次数和降低治疗的复杂程度。
结论
本实验运用数字化技术进行半侧颜面短小畸形的术前测量和精确的术前设计,设置最佳截骨手术方案；利用RP技术制作手术导板,引导手术过程,保证手术操作与术前设计思想的无缝衔接,提高了手术精确度,减少了手术操作难度；本研究还测量了6例患者的术前和术后半年的CT数据,并进行了部分数据的统计学分析,初步证实替牙期为半侧颜面短小畸形患者的最佳手术时机。
Objective
1Set up three-dimensional coordinate system of hemifacial microsomia (HFM)patients with three-dimensional CT (3DCT)imaging model. Analyze and measure the deformities of facial asymmetry.Designing preoperative scheme of distraction osteogenesis.
2Use rapid prototyping technique designs operative guide,accurately guiding mandiblular distractor implantation of hemifacial microsomia patients.
3Measure and statistically analyze the three-dimensional CT data of hemifacial microsomia before mandibular distractor implantation and after distractor removed,assessment the results of operations, improved surgical approach.
Study object and Methods
Study object12HFM patients treated in Plastic Surgery Hospital,Chinese Academy of Medical Sciences Centre, Maxillofacial Plastic Surgery from August2009to June2011were selected in the study.
Methods
1Input HFM patient's three-dimensional CT model data to medical software, calculating the mirro model data, and then input the two model data into industrial design software,looking for the best fitting plane,defining which as the symmytrical plane.Set the symmetrical plane as the median sagittal plane, then reset the three-dimensional coordinate system. Mark the anatomical landmarks,which should be accurate measured and analyzed in order to decide asymmetrical composition. Accurately design the position and orientation of distractor follow the results of measurement and analysis.
2Input patient's three-dimensional CT model data to medical software.Reconstruct the inferior alveolar neurovascular bundle, tooth etc, and then mark them at the outer cortex of mandible.Input all the data into industrial design software, and accurately design the osteotomy scheme.Desiged surgical guide using RP technology, guiding accurate designed osteotomy surgery. Unite preoperative design ideas and surgical procedures,simplifying surgical difficulty..reducing the risk of accidental injuries, reducing operation time and improving surgical results.
3Input patient's three-dimensional CT model data to industrial design software, and reset the three-dimensional coordinate system. Import postoperative three-dimensional CT model data,exact matching the preoperative data in order to unite them in the same three-dimensional coordinate system.Measure three-dimensional coordinate values of anatomical landmarks before and after the distraction osteogenisis, and calculate coordinates changes of skull anatomical landmarks, length, angle and anatomical plane.
Results
1After three-dimensional coordinate system was resetted, after accurate measured、analyzed and designed data of preoperation,12cases of hemifacial microsomia patients successfully completed mandibular distraction osteogenesis.
2Through using RP technique to produce digital guide of mandibular osteogenesis, surgical operation and preoperative design was well fitted. We realized the surgical design procedure perfectly, improving surgical precision and security.2patients had severe dysplasia on mandibular ramus, by accurate preoperation design and using surgical guide, had avoided the mandibular ramus reconstruction surgery, and the distraction process went smoothly.
3We measured6cases of hemifacial microsomia preoperation and postoperation three-dimensional CT data, and conducted a statistical analysis of some data. Measurement results confirmed that under the guidance of digital technology,mandibular distraction osteogenesis results were satisfactory. Data analysis confirmed that children in mixed dentition period have great growth potential on maxilla and zygoma.Distracition osteogenesis in this period can effectively reduce the operation times and the complexity of the surgery.
Conclusion
In this experiment we used digital surgery techniques for treatment of hemifacial microsomia patients.By preoperative measurement and analysis, dedign the best surgery program, and using RP technique to produce digital guide of mandibular osteogenesis, surgical operation and preoperative design was well fitted, we realized the surgical design procedure perfectly, improving surgical precision and security. We also measured6patients with preoperative and postoperative three-dimensional CT data, confirmed that children in mixed dentition period have great growth potential on maxilla and zygoma.Distracition osteogenesis in this period can effectively reduce the operation times and the complexity of the surgery. Mixed dentition period is the best timing of mandibular distraction osteogenesis.
引文
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