摘要
第一部分半侧颜面短小综合症患者头面部软组织对称性的三维测量及初步分析
研究目的：通过对CT扫描数据三维重建,对伴小耳畸形的半侧颜面短小综合症患者的头面部软组织进行CT扫描及数字模型的重建；通过测量软件对头面部对称性差异进行测量和分析,为伴小耳畸形的半侧颜面短小综合症患者的颜面畸形的矫正和外耳再造提供理论依据。
研究对象和方法：在2008年～2010年间入院的伴单侧小耳畸形的半侧颜面短小综合症的患者中,选择30例患者。对上述患者进行头颅CT扫描以及数字模型重建。在重建的三维数字模型上选择28个定点,通过测量软件进行测量,并进行初步的分析。测量内容包括：1、空间直线距离：2、弧度测量；3、角度测量；4、面积测量；4、体积测量；本研究的目的是对伴小耳畸形的半侧颜面短小综合症患者的头面部软组织的差异程度进行分析,数据分析以健侧头面部软组织为对照,测量并分析患侧头面部软组织与健侧的差异。测量结果通过SPSS13.0软件进行统计学分析。
结果：1、具有显著性统计学差异的有：双侧鼻翼点到X轴、Y轴的空间距离；双侧颊点到X轴、Y轴、Z轴的空间距离；双侧下颌角点到X轴、Y轴、Z轴的空间距离；双侧耳屏点到X轴的空间距离。2、弧长测量方面：所测量弧长均有显著性统计学差异。3、在角度测量方面：角度②、⑤、⑥有显著性统计学差异。4、面积测量方面：下颌区的面积、颧区的面积、颏区的面积具有显著性统计学差异。5、体积测量方面：下颌区的体积、颧区的体积、颏区的体积、颞区的体积具有显著性统计学差异。
结论：1、伴小耳畸形的半侧颜面短小综合症患者头面部不对称畸形是三维轴向的不对称畸形。2、除了小耳畸形外,下颌区畸形是伴小耳畸形的半侧颜面短小综合症面部不对称的主要表现和手术治疗的重点。3、外眦、鼻翼,畸形程度较轻,下颌角点和耳屏点不对称程度最明显。4、颞区的畸形直接影响外耳再造时耳支架的雕刻和放置。
第二部分三维颅骨模型在外耳再造耳支架放置位置选择中的应用研究
研究目的：探讨三维颅骨模型在外耳再造耳支架位置选择中的应用,比较使用三维颅骨模型和未使用三维颅骨模型对耳支架放置位置选择的影响,为外耳再造术提供新的思路。
研究对象和方法：在2008年3月～2010年3月间入院的患者中,选取应用自体肋软骨支架移植外耳再造、单侧小耳畸形的半侧颜面短小的患者40例,其中20例术前头颅CT扫描,并利用快速成型技术制作出三维颅骨模型作为术前设计耳支架放置位置的模板,并在术后半年后进行随访调查。同时随机随访未应用三维颅骨模型进行术前设计的患者20例做对照组。随访调查内容包括：1、评价再造耳廓位置的对称性。应用SPSS 13.0软件,用卡方检验进行分析应用和未应用三维颅骨模型在再造耳位置对称性方面的差异有无显著性意义。2、评价颅耳角的差异。应用SPSS 13.0软件,用卡方检验进行分析应用和未应用三维颅骨模型在再造耳的耳颅角的差异有无显著性意义。
结果：1、在再造耳廓位置及对称性方面,应用三维颅骨模型的患者组与未应用三维颅骨模型的患者组,两者之间的差异有显著的统计学意义(P=0.0424,P＜0.05)。2、在再造耳颅耳角方面,应用三维颅骨模型的患者与未应用三维颅骨模型的患者,两者之间无显著性差异(P=0.799,P＞0.05)
结论：应用三维颅骨模型在外耳再造术前耳支架放置位置确定方面具有临床价值,是一种技术上的进步,有利于提高手术效果。
第三部分小耳畸形患者的再造耳有限元模型研究
目的：通过建立再造耳有限元模型,验证该系统的可行性和实用性。寻找解决耳再造手术术难以预测术后外耳形态变化障碍的最佳途径,并探索新的、更有效的手术方法。
方法：选择1例伴单侧小耳畸形的半侧颜面短小患者一例,于外耳再造术后半年,进行头面部三维螺旋CT扫描,对外耳结构进行三维重建,对已构建的再造耳的三维几何模型采用手工划分的方式构建网格。然后应用有限元软件包ANSYS对划分的网格结构进行有限元分析,建立再造耳有限元模型。模型建立后,应用有限元软件包ANSYS对不同时间点的变化进行分析。
结果：获取的再造耳有限元模型由52566个单元和84787个网格点组成。该模型在一定程度上反映了再造耳的生物力学性能,具有真实有效性。术后再造耳的形态变化均以数据和图像两种形式输出。经模拟后的软组织特征点的受力最显著的是外耳轮上缘、其次是舟状窝,其他标志点变化不大。再造耳形变的结果,提供了对外耳再造手术的手术方案进行修订,具有很高的临床应用价值。
结论：本实验应用有限元技术,建立了一个能够反映外耳部分软组织生物力学性能,包含皮肤、软骨支架的有限元模型；并可以在患者再造耳有限元模型上进行手术后形变的模拟和预测。
The First Part
The Three-Dimensional Measurement and Preliminary Analysis of the Symmetry of Cranial Soft Tissue of the Patients of The Hemifacial Microsomia Patients with Microtia
Objective:To obtain the CT scanning data and reconstruct digital model of the cranial soft tissue of the patients of the hemifacial microsomia patients with microtia by three-dimensional CT scanning technique. To measure and analyze the symmetry of cranial soft tissue preliminarily. To provide theoretical proof of cranial soft tissue in the patients with hemifacial microsomia patients.
Methods:A total of 30 cases of patients of the hemifacial microsomia patients with microtia who underwent auricular reconstruction between 2008 and 2010 were chosed. After obtainning the data and reconstructing digital skull model of the patients, we selected 28 mark points in the digital model to measure and analyzed the symmetry of cranial soft tissue preliminarily. The measurement data contained:1. the measurement of space distance.2.The measurement of radian.3. The measurement of angle.4. The measurement of area.5. The measurement of volume. The data were analyzed by SPSS 13.0
Result:1. In all the mark points, the items with significant statistics difference were:the space distance from alae nas point to X axis and to Y axis, the cheek point to X axis、Y axis and to Z axis; gonial angle point to X axis,Y axis and to Z axis;tragion point to X axis.2. In the arc length:all the arc length which were measured had significant statistics difference.3. In the angle which was measured, the second, the fifth and the sixth had significant statistics difference.4. In all the area measured,, the items had significant statistics difference were: the area of mandibular area, zygomatic region, and mental region.5. In all the area measured, the items with significant statistics difference were:the area of mandibular area, zygomatic region and mental region. 5. In all the volume measured, the items with significant statistics difference were:the volume of mandibular area, zygomatic region, mental region and temperal region.
Conclusion:1. The asymmetric deformity of cranial soft tissue in the hemifacial microsomia with microtia was multi-aspect deformity.2. Except for microtia, the deformity of mandibular area was the principal appearance and the key of the treatment.3. The degree of deformity of the angulus oculi lateral is and alae nas were fairly light, and the most severe deformity existed in the tragion point and mandible point.4.The deformity of temporal region has direct relationship with the f ibracation and location of ear framework.
The Second Part
The Application of the Three-Dimensional skull Mould in the choice of the auricular framework location in the reconstruction of the external ear
Objective:To probe the application of the three-dimensional skull mould in the choice of the auricular framework location in the reconstruction of the external ear. To compare the two groups with or without using the three-dimensional skull mould in the choice of the auricular framework's location in the ear reconstruction.
Methods:We selected 20 cases of patients of hemifacial microsomia with unilateral microtia who underwent auricular reconstruction between 2008 and 2010. Three-dimensional CT scanning technique and rapid prototyping technology were used to manufacture three-dimensional skull mould of the patient before the operation.40 cases of patients were followed up. Two groups of the shape and symmetry of the reconstructed auricle were compared by 4 surgeons, and two groups of the cranioauricular angle were compared also. The data were analyzed by SPSS 13.0 and Pearson'X2 test.
Result:1. The patients using the three-dimensional skull mould were compared with those without using skull mould in the shape and symmetry of the reconstructed auricle and it showed significant difference statistically (P= 0.0424, P<0.05).2. The patients using the three-dimensional skull mould were compared with those without using the skull mould in the cranioauricular angle of the reconstructed auricle and it showed no significant difference statistically (P=0.799, P>0.05).
Conclusion:Three-dimensional skull mould has clinical value in the ear reconstruction. It was technical improvement in the ear econstruction.
The third Part
Finite element modeling study of the reconstructed ear in patients with microtia
objective:The purpose of this research is to create 3D finite element model of reconstructed ear, To create a system for predicting the reconstructed ear deformation. To investigate a more effective method for ear sugery.
Material and methods:
Finite Element modeling study of one patient of the hemifacial microsomia patient with microtia was carried out after CT scanning and reconstruction of the ear. Development of 3D finite element model of the ear boundary conditions were set and the mesh was manually made by using tetrahedrons on the basis of 3 CAD models of skin, and cartilage framework. Finite element model of the reconstructed ear was then developed by means of ANSYS software package. Surgical simulation and prediction of reconstructed deformation resulting from different skin retraction rates in the future.The different time points were chosen to evaluate the ear deformation by means of ANSYS soft warepackage. The reconstructed ear was evaluated at different time points.
Result:There were 52566 elements and 84787 nodes in the reconstructed ear. Finite element model of the ear reflected the biomechanical features in some respect. Results were outputed in form of medical images. The most apparent tissue displacement was superior helix of the renconstructed ear, followed with scaphoid fossa. And tragus is the least affected.
Conclusion:This paper addressed to create a digital model of the reconstructed ear on the bas is of finite element method. The post-operation ear deformation could be predicted.The paper focused on the prediction of reconstructed ear deformation resulting from the skin tissue retraction.
引文
[1]王炜主编.整形外科学[M].浙江：浙江科学技术出版社.1999.
[2]Russell R, Carl W, Andres J. Hemifacial microsomia and treatment options for auricular replacement:A review of the literature[J]. J Prosthet Dent,1999; 82:197-204.
[3]韩德民主编.2008耳鼻咽喉头颈外科新进展[M].北京：人民卫生出版社,2008：1—3.
[4]刘兴国.新生儿先天性畸形发生率[J].中华医学杂志,1978,58(1)：24—28.
[5]朱军,王艳萍,梁娟,等.1988—1992年全国先天性无耳和小耳畸形发病率的抽样调查[J].中华耳鼻喉科杂志,2000,35(1)：62—65.
[6]陈佳鹏,张蕾,陈功,等.中国1993—1998年出生缺陷监测能力分析[J].中华流行病学杂志,2006,27(5)：392—395.
[7]Tanzer RC. Microtia—a long-term follow-up of 44 reconstructed auricles[J]. Plast. Reconstr. Surg,1978, Feb,61(2):161-6.
[8]Tanzer RC. Microtia[J]. Clin. Plast. Surg,1978,5:317.
[9]Brent B. Byrd H. S. Secondary ear reconstruction with cartilage grafts covered by axial, random, and free flaps of temporoparietal fascia[J]. Plast. Reconstr. Surg,1983,72 (2):141-51.
[10]Brent B. Microtia repair with rib cartilage grafts:a review of personal exerprience with 1000 cases[J]. Clin. Plast. Surg,2002, 29(2):257-272.
[11]Brent B. Technical advances in ear reconstruction with autogenous rib cartilage grafts:personal experience with 1200 cases [J]. Plast. Reconstr. Surg,1999,104 (2):319-334.
[12]Brent B:The correction of microtia with autogenous cartilage grafts: I. The classic deformity[J]. Plast. Reconstr. Surg,1980,66:1-12.
[13]Brent B:The correction of microtia with autogenous cartilage grafts: Ⅱ. Atypical and complex deformities [J]. Plast. Reconstr. Surg,1980,66: 13-21.
[14]Fukuda 0. Long-term evaluation of modified Tanzer ear reconstruction[J]. Clin. Plast. Surg,1990,17 (2):241-49.
[15]Nagata, S. Modification of the stages in total reconstruction of the auricle:Part I. Grafting the three-dimensional costal cartilage framework for lobule-type microtia[J]. Plast. Reconstr. Surg,1994, 93(2):221-30.
[16]Nagata, S.Modification of the stages in total reconstruction of the auricle:Part II. Grafting the three-dimensional costal cartilage framework for concha-type microtia[J]. Plast. Reconstr. Surg,1994, 93(2):231-42
[17]吴近芳,陈文馨,李大涛,张如鸿,张群.全耳再造一期术后负压引流与再造耳形态的探讨50例[J].组织工程与重建外科杂志,2009,5(4)：213-214.
[18]许枫,晋培红,张如鸿.Nagata法全耳再造的临床应用研究[J].浙江大学学报,2007,36(6)：604-608.
[19]Nagata S. Modification of the stages in total reconstruction of the auricle [J]. Plast. Reconstr. Surg,1994,93(2):221-266.
[20]汪希,陈骏,杨群,钱云良.耳再造术中自体肋软骨耳支架的雕刻[J].中国美容整形外科杂志,2008,19(3)：163-165
[21]Neuman CG. The expansion of an area of skin by progressive distension of a subcutaneous balloon[J]. Plast. Reconstr. Surg,1957,19:124.
[22]Hata Y, Hosokawa K, Yano K, et al. Correction of microtia using the tissue expander[J]. Plast. Reconstr. Surg,1989,84 (5):741-51.
[23]Tanino R, Miyasaka M. Reconstruction of microtia using tissue expander[J].Clin. Plast. Surg,1990,17(2):339-53.
[24]庄洪兴,蒋海越,潘博等.先天性小耳畸形皮肤软组织扩张法外耳再造术[J].中华整形外科杂志,2006,22(4)：286-289.
[25]周来喜,罗静,光子脱毛联合较大体积扩张器法外耳再造术的护理.中国美容医学[J].2009,18(8)：1190-1191
[26]刘嘉锋,孙家明,张一呜,李小丹.光子脱毛联合较大体积扩张器法行外耳再造的临床研究[J].中国修复重建外科杂志,2007,21(9)：921-924
[27]宋春琼,庄洪兴,王淑杰,等.扩张的耳后瘢痕瓣和Medpor支架耳廓烧伤后再造术[J].中华整形外科杂志,2006,22：427-429.
[28]张志钢,郑亿庆,刘翔,陈穗俊.骨整合义耳修复创伤性全耳廓缺损[J].中国耳鼻咽喉头颈外科.2008,15(10)：559-561
[29]Thome CH, Brecht LE, Bradley JP, et al Auricular reconstruction: Indications for autogenous and prosthetic technique[J]. Plast Reconstr. Surg,2001,107:1241-1251.
[30]James W, Romo T, Sclafani A, et al Porous high-density polyethy- lene implants in auricular reconstruction[J]. Arch Otolaryngol Head Neck,1997.123:578-583
[31]Wellisz T. Reconstruction of the burned external ear using a Medpor porous polyethylene pivoting helix framework[J]. Plast Reconstr Surg. 1993 Apr;91(5):811-8.
[32]Romo T 3rd, Reitzen SD. Aesthetic microtia reconstruction with Medpor[J]._Facial Plast Surg.2008 Jan;24(1):120-8.
[33]Zhao Y, Wang Y, Zhuang H, Jiang H, Jiang W, Hu X, Hu S, Wang S, Pan B. Clinical evaluation of three total ear reconstruction methods[J].J Plast Reconstr Aesthet Surg.2009 Dec;62(12):1550-4.
[34]吴建明,吴包金,林子豪.四种耳郭支架材料全耳再造的临床应用评估[J].中国实用美容整形外科杂志.2004;15(6)：297-299
[35]Thomson HG, Winslow J. Microtia reconstruction:does the cartilage framework grow? [J] Plast. Reconstr. Surg.1989 Dec; 84(6):908-15.
[36]戚可名,博洁,熊斌等.国人耳廓发育调查—兼论外耳再造的年龄选择[J].中华整形烧伤外科杂志,1990；6(2)：136-137.
[37]Horlock NM, Vogelin E, Bradbury ET. et al. Psychosocial Outcome of Patients after Ear Reconstruction:A Retrospective Study of 62 Patients[J]. Annals of Plastic Surgery.2005; 54(5):517-524.
[38]杨庆华,庄洪兴。曾衍均。郭碧云。郭万厚。谢祥,肋软骨生物力学性能及在耳廓再造手术时机选择中的意义[J].中华整形外科杂志.2008；24(2)：104-107
[39]Fento O, Complications of soft tissue expansion disscuss[J]. Br J Plast Surg,1999,41:249.
[40]Brown Md, Johnson TM. Complication of tissue expansion[J]. J Dermatol Surg Oncal,1993,19:1120-1122
[41]郭万厚,庄洪兴,等.耳后扩张皮瓣破溃后的手术处理[J].中华整形外科杂志,2006；22(5)：396-397
[42]Epply, Barry LMD. Alloplastic implantation[J]. Plast Reconstr surg,1999,104:1761-1785.
[43]邹艺辉,王淑杰,薛峰,庄洪兴.皮瓣展平法在耳廓再造时扩张皮瓣感染中的应用.解放军医学杂志,2006,31(12)：1187-1188
[44]Song YG, Song YL. An improved one-stage total ear reconstruction procedure[J]. Plast. Reconstr. Surg,1983,71 (5) 615-22.
[45]Hirase Y, Kojima T, Hirakawa M. Secondary ear reconstruction using deep temporal fascia after temporioparietal fascial econstruction in microtia[J]. Ann. Plast. Surg,1990,25(1):53-7.
[46]何芨,郭宝增.外耳再造术后辅助高压氧治疗35例[J].中华航海医学与高气压医学杂志,2002,9(1)：43-44.
[47]方健,肖立国,程晋成,等.高压氧综合治疗肢体多部位大面积剥脱伤[J].中华航海医学杂志,1998,5：78-80.
[48]康月,高建章,方以群.高压氧对兔肢体缺血再灌注损伤的作用[J].中华理疗杂志,1994,17：208.
[49]杜佳梅。庄洪兴,蒋海越,等.先天性小耳畸形患者及其家属心理状况调查研究[J].中华整形外科杂志,2005,21(3)：218-221.
[50]张广霞,翟凤英.外耳再造术患者的心理问题及护理干预[J].中国美容医学,2009；18(7)：1021
[51]Cao YL, Vacanti JP, Paige KT, et al. Transplantation of chondrocytes utilizing a polymer-cell constructs to produce tissue-engineered cartilage in the shape of a human ear[J]. Plast. Reconstr. Surg,1997,100 (2):297-302.
[52]Rodriguez A, Cao YL, Ibarra C, et al. Characteristics of cartilage engineered from human pediatric auricular cartilage [J]. Plast. Reconstr. Surg,1999,103(4):1111-1119
[53]Kamil S, Vacanti MP, Vacanti CA.et al. Microtia Chondrocytes as a Donor Source for Tissue-Engineered Cartilage[J]. Laryngoscope,2004; 114(12):2187-2190.
[54]Lin Z, Fitzgerald JB, Xu J, et al. Gene expression profiles of human chondrocytes during passaged monolayer cultivation[J]. J Orthop Res, 2008,26:1230-1237.
[55]Kang SW, Yoo SP, Kim BS. Effect of chondrocyte passage number on histological aspects of tissue-engineered cartilage [J]. Biomed Mater Eng, 2007,17:269-276.
[56]Im GI, Jung NH, Tae SK. Chondrogenic differentiation of mesenchymal stem cells isolated from patients in late adulthood:the optimal conditions of growth factors[J]. Tissue Eng,2006,12:527-536.
[57]Indrawattana N, Chen G, Tadokoro M,et al. Growth factor combination for chondrogenic induction from human'mesenchymal stem cell[J]. Biochem Biophys Res Commun,2004,320:914-919.
[58]Worster AA, Brower-Toland BD, Fortier LA, et al. Chondrocytic differentiation of mesenchymal stem cells sequentially exposed to transforming growth factor-betal in monolayer and insulin-like growth factor-I in a three-dimensional matrix [J]. J Orthop Res,2001,19:738-749.
[59]Worster AA, Nixon AJ, Brower-Toland BD, et al. Effect of transforming growth factor betal on chondrogenic differentiation of cultured equine mesenchymal stem cells[J]. Am J Vet Res,2000,61:1003-1010.
[60]Thomson JA, Itskovitz-Eldor J, Shapiro SS, et al. Embryonic stem cell lines derived from human blastocysts[J]. Science,1998,282:1145-1147.
[61]Lerou PH, Daley GQ. Therapeutic potential of embryonic stem cells [J]. Blood Rev,2005,19:321-331.
[62]Liu Y, Chen F,. Liu W, et al. Repairing large porcine full-thickness defects of articular cartilage using autologous chondrocyte-engineered cartilage[J]. Tissue Eng,2002,8:709-721.
[63]Zhou G, Liu W, Cui L, et al. Repair of porcine articular osteochondral defects in non-weightbearing areas with autologous bone marrow stromal cells[J]. Tissue Eng,2006,12:3209-3221.
[64]Kelley PE, Scholes MA. Microtia and congenital aural atresia[J]. Otolaryngol Clin North Am,2007,40(1):61-80.
[65]Wilkes GH, Wolfaardt J F. Osseointegrated alloplastic versus autogenous ear reconstruction:criteria for treatment selection[J]. Plast Reconstr Surg,1994,93 (5):967.
[66]Gumieiro EH, Dib LL, Jahn RS, dos Santos Junior JF, Nannmark U, Granstrom G, Abrahao M. Bone-anchored titanium implants for auricular rehabilitation:case report and review of literature[J]._Sao Paulo Med J.2009; 127 (3):160-5.
[67]Ban k Son D Osseointeglated atloplastic ear reconstruction with the implant—carrying plate system in children[J]. Plast Reconstr Surg,2000,109:496-503
[68]Falcone MT, Labadie RF. An alternate approach for surgical dressing of bone-anchored hearing aid abutment sites [J]. Laryngoscope.2007 Apr; 117(4):614-6.
[69]邵龙泉,赵铱民,赵信义.SY-1和MDX4-4210硅橡胶拉伸性能、邵氏硬度的测定[J].实用口腔医学杂志,2004 Mar,20(2)：201-3.
[70]Botma M, Aymat A, Gault D, et al. Rib graft reconstruction versus osseointegraled prosthesis for microtia:a significant change in patient preference[J]. Clin Otolaryngol Allied Sci,2001.26:274-277.
[71]Bennum RD, Mulliken JB, et al.Microtia:a microform of hemicial microsomia[J]. Plast Reconstr Surg,1985,76(6):859-65
[72]Keogh IJ, Troulis MJ, Monroy AA, et al. Isolated microtia as a marker for unsuspected hemifacial microsomia[J]. Arch Otolaryngol Head Neck Surg 2007:133:997-1001
[73]Kaban LB, Moses MH, Mulliken JB. Surgical correction of hemifacial mi-crosomia in the growing child[J]. Plast Reconstr Surg,1988,82(1):9.
[74]Vento AR, LaBrie RA, Mulliken JB. The 0. M. E. N. S. classification of hemifacial microsomia[J]. Cleft Palate Craniofacial Journal,1991,28: 682.
[75]Tanzer. R. C, Secondary reconstruction of microtia[J]. Plast. Reconstr Surg.1969,43:345
[76]Brent B. Total auricular reconstruction with sculpted costal cartilage. In B. Brent (Ed.), the Artistry of Reconstructive Surgery[M]. St. Louis:Mosby.1987
[77]Moss, J. P, Linney, A. D, Grinrod, S. R, et al. A CT scanning system for the measurement of facial surface morphology [J]. Optics CT Eng.10:179, 1989.
[78]Gougoutas AJ, Singh DJ, Low DW, Bartlett SP. Hemifacial microsomia: classification system[J]. Plast Reconstr Surg.2007,120(7):112e-120e.
[79]Keogh IJ, Troulis MJ, Monroy AA, et al. Isolated microtia as a marker for unsuspected hemifacial microsomia [J]. Arch Otolaryngol Head Neck Surg 2007:133:997-1001
[80]Farkas L G, Eiben 0 G, Sivkov S, et al. Anthropometric measurements of the facial framework in adulthood:age-related changes in eight age categories 16 to 90 years of age[J]. Craniofacial Surg,2004, 15(2):288-298.
[81]Huisinga-Fischer CE, Zonneveld FW, VaandragerJM, Prahl-Andersen B. CT-based size and shape determination of the craniofacial skeleton:'a new scoring system to assess bony deformities in hemifacial microsomia[J]: Craniofac Surg.2001 Jan; 12(1):87-94.'
[82]Keogh IJ, Troulis MJ, Monroy AA, et al. Isolated microtia as a marker for unsuspected hemifacial microsomia[J]. Arch Otolaryngol Head Neck Surg 2007;133:997-1001
[83]McCarthy JG. Craniofacial microsomia[J]. Clin PlastSurg,1997,24:459-474.
[84]Kaban LB, Mulliken JB, Murray J E. Three dimensional approach to analy sis and treatment of hemifacial microsomia[J]. Cleft Plast J,1981,18:902
[85]Yip E, Smith A, Yoshino M. et al. Volumetric evaluation of facial swelling utilizing a 3-D range camera[J]. Int J Oral Maxillofac Surg, 2004,33(2):179-182.
[86]Jayaprakash PT,Srinivasan GJ, Amravaneswaran MG. Cranio-facial morphanalysis:a new method for enhancing reliability while identifying skulls by photo superimposition[J]. Forensic Sci Int,2001,110(1): 121-143.
[87]Chen LC, Lizuka T. Evaluation and prediction of the facial appearance after surgical correction of mandibular hyperplasia[J]. Int J Oral Maxillofac Surg,1995。 24(5):322-326.
[88]Jayaratne YS, Lo J, Zwahlen RA, Cheung LK. Three-dimensional photogrammetry for surgical planning of tissue expansion in hemifacial microsomia[J]. Head Neck.2009 Oct 27. [Epub ahead of print]
[89]沈云娟,陈慧霞,许晓聪.常州地区正常青少年X线头影测量研究[J].检验医学与临床,2009,14(6)：1135-1136
[90]郭宏铭,白玉兴,周立新等.正常牙合头面部软组织三维测量[J].北京口腔医学,2001,9(3)：125-128.
[91]白玉兴,郭宏铭,周立新等.Ⅱ类与Ⅰ类错牙合头面部软组织三维结构的特征与比较研究[J].现代口腔医学杂志.2002,16(3)：243-245.
[92]Ferrario VF, Sforza C,Pellavia C, et al.A quantitative three-dimensional assessment of soft tissue facial asymmetry of cleft lip and palate adult patients[J]. J Craniofacial Surg,2003,14(5):739-746.
[93]Ferrario VF, Sforza C, Pellavia C, et al.Three-dismensional nasal morphology in cleft lip and palate operated adult patients[J]. Annals Plastic surg,2003,51(4):390-397.
[94]刘林,许天民,张益等.CT扫描在面部畸形三维重建及测量中的初步应用[J].口腔医学,2005,25(6)：345-347.
[95]Mccance AM, Moss JP,Fright WR,et al. Three-dimensional analysis techniques-part 2:CT scanning:aquantilative three-dimensional soft-tissue analysis using a color-coding system[J]. Annals Plastic surg, 2004,53(6):577-583.
[96]0 Grady KF, Avitonyshyn OM. Facial asymmetry:three-dimensional analysis using CT surface scanning[J]. Plast Reconstr Surg,1999, 104(7):928-937.
[97]Pruzansky, S. Not all dwarfed mandibles are alike[J]. Birth Defects 1:120,1969.
[98]Murray JE, Kaban LB, Mulliken JB. Analysis and treatment of hemifacial microsomia[J]. Plast Reconstr Surg,1984,74:186-199.
[99]Snyder CC, Levine GA, Swanson HM. Mandibular lengthening by gradual distraction:preliminary report[J]. Plast Recontr Surg,1973,51 (5) 506.
[100]McCarthy J G, Schreiber JB, Karp NS, et al. Lenghtening the Human mandible by gradual distraction [J]. Plast Reconstr Surg,1992,89 (1): 1-8.
[101]McCarthy J G. The role of distraction osteogenesis in the reconstruction of the mandible in unilateral craniofacial microsomia[J]. ClinPlastSurg,1994,21(4):625.
[102]Sugihara T, Kawashima K, Igawa H, et al. Mandibular lengthening by gradual distraction in humans[J]. Eur J Plast Surg,1995,18 (1):7.
[103]庄洪兴,罗家麟,廖杰等.耳颌畸形的治疗[J].中华整形烧伤外科杂志,1996,1(3)：196-197.
[104]尹琳,刘剑锋,牛峰等.颧骨L形截骨扩展术矫正颧骨过小畸形[J].中国美容医学,2009,18(3)：313-315
[105]姚玉胜,柳春明,常世民.长期犬上颌缝牵引的组织学研究[J].临床口腔医学杂志,2009,25(1)：33-35
[106]归来,张智勇,滕利,等.下颌骨外板修复颅颌面畸形[J].实用美容整形外科杂志,2000,11：178-180.
[107]邹丽剑,冯胜之,施耀明,等.带蒂颞浅筋膜瓣复合真皮脂肪修复面部凹陷畸形的疗效评价[J],中华整形外科杂志,2000,16(6)：340-343。
[108]范先群,沈勤,李海生,等.眼眶爆裂性骨折伴眼球内陷的眼眶容积测量[J].中华眼科杂志,2002,38(1)：39-41.
[109]Delong R, Heinzen M, Hodges JS, et al. Accuracy of a system for creating 3D computer models of dental arches[J]. Dent Res,2003,82(6):438-442
[110]Majumdar S. Advances in imaging:impact on studying craniofacial bone structure[J]. Orthod Craniofac Res,2003,6(Suppl 1):48-51
[111]刘东旭,王春玲,刘莉,等.颅面部螺旋CT三维线距测量的准确性评价[J].上海口腔医学,2006,15(5)：517-520.
[112]Katsumata A, Fujishita M, Maeda M,3D-CT evaluation of facial asymmetry[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod.2005, 99(2):212-20.
[113]HwaIlg HS, Hwang CH, Lee KH, et al. Maxillofacial 3-dimensional image analysis for the diagnosis of facial asymmetry [J]. Am J Orthod Dentofacial Orthop,2006,130(6):779-785.
[114]刘光富,张曙,利用快速原型技术构建医学模型[J].制造业自动化,2001,23(6) 1-4
[115]Zhou L, He L, Shang H, Liu G, Zhao J, Liu Y. Correction of hemifacial microsomia with the help of mirror imaging and a rapid prototyping technique:case report [J]. Br J Oral Maxillofac Surg.2009 ep;47(6):486-8.
[116]Zanakis NS, Gavakos K, Faippea M, Karamanos A, Zotalis N. Application of custom-made TMJ prosthesis in hemifacial microsomia[J]. Int J Oral Maxillofac Surg.2009 Sep;38(9):988-92.
[117]Tanzer, RC. Total reconstruction of the external ear[J]. Plast Reconstr Surg,1959,23(1):1-15.
[118]Pierce, G. W. Reconstruction of the external ear[J]. Surg. Gynecol. Obstet,1930,50(6):601-5.
[119]Fukuda 0. Long-term evaluation of modified Tanzer ear-reconstruction[J].Clin. Plast. Surg,1990,17(2):241-49.
[120]Brent. B. The correction of microtia with autogenous cartilage grafts:II. Atypical and complex deformities[J]. Plast Reconstr Surg, 1980,66(1):13-21.
[121]Gillies, H. D. Plastic Surgery of the Face[M]. London, H. Frowde, Hodder& Stoughton,1920.
[122]Nagata, S.Modification of the stages in total reconstruction of the auricle:Part I. Grafting the three-dimensional costal cartilage framework for lobule-type microtia[J]. Plast. Reconstr. Surg,1994,93(2): 221-30.
[123]Brent B. Auricular repair with autogenous rib cartilage grafts:two decades of experience with 600 cases[J]. Plast Reconstr Surg,1992, 90(3):355-74;discussion 375-6
[124-]Radovan C. Tissue expansion in soft-tissue reconstruction [J]. Plast Reconstr Surg,1984,74(4):482-92.
[125]Hata Y, Hosokawa K, Yano K, et al. Correction of microtia using the tissue expander[J]. Plast Reconstr Surg,1989,84(5):741-51.
[126]Tanino R, Miyasaka M. Reconstruction of microtia using tissue expander[J]. Clin Plast Surg,1990,17(2):339-53.
[127]庄洪兴,蒋海越,潘博等.先天性小耳畸形皮肤软组织扩张法外耳再造[J].中华整形外科杂志,2006,22(4)：286-289.
[128]Dashan Y, Haiyue J, Qinghua Y, et al. Technical innovations in ear reconstruction using a skin expander with autogenous cartilage grafts [J]. J Plast Reconstr Aesthet Surg,2008;61, Suppl 1:S59-69.
[129]Yang QH, Song YP, Jiang HY, He LR, Wang SJ. Timing ear reconstruction by biomechanical properties of the rib cartilage:is childhood the best operative time[J]? Plast Reconstr Surg,2009,124(6):440e.
[130]Yamada A, Ueda K, Yorozuya-Shibazaki R. External ear reconstruction in hemifacial microsomia[J]. J Craniofac Surg,2009,20, Suppl 2:1787-93.
[131]闫晋,沈国芳.宋丽媛.三维CT对颅颌面骨性结构的测量与分析[J].口腔颌面外科杂志,2009,1(4)：261-266
[132]唐荣高.医学图像三维规划系统辅助面部整形设计的研究[J].组织工程与重建外科杂志,2009,5(4)：208-211
[133]刘亚雄,李涤尘,卢秉恒,等.快速成型在口腔颌面修复中的应用—下颌骨替代物的原位设计[J].实用口腔医学杂志,2002,18(5)：395-397
[134]归来,夏德林,张智勇,等,三维模型技术在颅面创伤修复中的应用[J]中华创伤杂志,2004,20(4)：213-216
[135]陈俊,吕培军,冯海兰,等.牙颌模型CT扫描系统的可靠性研究与手工测量的比较[J].现代口腔医学杂志,2000,14：251-253.
[136]戚可名,博洁,熊斌等.国人耳廓发育调查—兼论外耳再造的年龄选择[J]中华整形烧伤外科杂志,1990,6(2)：136-137
[137]Tanzer, R. C. The Correction of Microtia. In B. Brent (Ed.), The Artistry of Reconstructive Surgery[M]. St. Louis:Mosby.1987
[138]Thomson HG, Winslow J. Microtia reconstruction:does the cartilage framework grow[J]? Plast Reconstr Surg,1989,84(6):908-15
[139]肖水生,胡静.快速成型技术及其在颅颌面外科中的应用[J].重庆医学.2002,31(12)：1250-1251.
[140]Santler G, Karcher H, Ruda C. Indication and limitations of three-dimensional models in cranio-maxillofacial surgery[J]. J Craniomaxillofacial Surg,1998,26(1):11-16
[141]Chan Dc, Frzier KB, Tse LA, et al. Application of rapid prototyping to operative dentistry curriculum[J]. J Dent Educ,2004,68(1):64-70.
[142]Zemmann W, Santler G, Karcher H. Analysis of midface asymmetry in patients with cleft lip, alveolus and palate at the age of 3 months using 3D-COSMOS measuring system[J]. Craniomaxillofacial Surg,2002,30 (3):148-152
[143]刘彦普,龚振宇,何黎升,等.大块下颌骨缺损的个体化数字设计及外形与功能重建[J].中国修复重建外科杂志,2005,19(10)：803-806.
[144]王悦,周中华.快速成型技术在口腔颌面外科的应用[J].上海生物医学工程,2005,26(1)：49-51.
[145]夏德林,归来,张智勇,等.快速成型技术——三维头颅模型的制作及在颅颌面创伤修复中初步应用一例[J].中国修复重建外科杂志,2005,19(10)：811-814.
[146]Davies N, Landay J, Hudson S, et al. Rapid prototyping for ubiquitous computing[J]. IEEE Pervasive Comput,2005,4(4):15-17.
[147]朱赴东,赵士芳,谢志坚,等.快速成型技术在正颌外科中的应用[J].解剖学报,2006,37(5)：563-567.
[148]杨莉玲,孙文磊,赵群.基于快速成型的颅骨断层影像模型重建的探讨[J].组合机床与自动化加工技术,2007,51(1)：41-45.
[149]归来,张智勇,滕利,等.下颌骨外板修复颅颌面畸形[J].实用美容整形外科杂志,2000.11(4)：178-180.
[1501]黄绿萍,归来,张智勇,等.不对称性下颌角肥大的手术治疗[J].华西口腔医学杂志,2004,22(1)：40—42.
[151]Peltomaki T, Hakkmen L, Growth of the ribs at the costochondral junction in the-rate[J]. T Anat,1992,181:259
[152]Gregory A, Lipczynski RT. The three dimensional reconstruction and monitoring of facial surfaces [J]. Med Eng Phys,1994,16(3):249-252
[153]陈琼·三维有限元建模方法的研究现状[J].口腔医学,2006,26(2)：154—155.
[154]白玉兴,郭宏铭.颅面软组织形态三维重建及测量研究进展[J].国外医学口腔分册,2000,27(4)：220-222.
[155]张彤,刘洪臣,王延荣,等.上颌骨复合体三维有限元模型的建立[J].中华口腔医学杂志,2000,35(5)：374-376.
[156]牛晓明,李江,吴清文.利用CAD/CAE技术进行骨骼的计算机模拟仿真[J].光学精密工程,1999,7(6)：85-89
[157]王兆星,董福慧正常人的软组织张力测定[J].中国骨伤,2004,17(1)：13-15[158]过邦辅,临床骨科生物力学基础[M],上海：第二军医大学出版社,1998.102-126.
[159]Fung YC. Biomechanics:Mechanical Properties of Living Tissues [M]. Springer, New York.1993.
[160]Swann AC, Seedhom BB. Improved techniques for measuring the indentation and thickness of articular cartilage [J]. Proc Inst Mech Eng H,1989,203 (3):143-150
[161]李晋唐,主编。骨及软组织流变学概论[M].第1版。成都：成都科技大学出版社,1990,103-108.
[162]张正文,孙广慈,胡华新.扩张皮肤远期回缩的规律及机制[J].中华医学美容杂志,2000,6(4)：189-191.
[163]Rudolph R. The effect of skin graft preparation on wound contraction [J]. Surg Gynecol Obstet,1976:142:49-56.
[164]Baran NK, Horton CE. Growth of skin grafts, flaps, and scars in young minipigs[J]. Plast Reconstr Surg,1972,50:487-96.
[165]郭晓霞,刘建生.金属塑形有限元后处理中动态云图的研究[J].锻压技术,2000,(5)：13-15.
[166]余洪谦,胡于进,等.结构分析可视化系统FEV S的设计与实现[J].华中理工大学学报,1996,24(3)：1-5.
[167]闵作兴,陈国华,吴衍平.发动机有限元可视化应用软件研究[J].华中理工大学学报,1999,27(11)：56—58.
[168]杨庆华,庄洪兴,肋软骨生物力学性能及在耳廓再造手术时机选择中的意义[J].中华整形外科杂志,2008,24：104-106.
[169]Huiskes R, Chao EY. A survey of finite element analysis in orthopedic biomechanics:the first decade[J]. J Biomech,1983,16(6):385-409
[170]朱静.有限元分析方法在口腔临床中的应用进展[J].上海生物医学工程,2003,24(3)：53—56.
[171]于力牛,张睿,李玲,等.模块化牙列三维有限元模型的建立[J].上海口腔医学,2000,9(4)：237—239.
[172]周学军,赵志河,赵美英,等.包括下颌骨的颞下颌关节三维有限元模型的建立[J].实用口腔医学杂志,2000,16(1)：17—19.
[173]张富强,魏斌,于力牛,等.个性化牙颌组织三维有限元模型库的建立[J].上海口腔医学,2004,13(2)：110—112.