基于三維數(shù)字化技術(shù)的先天性顱縫早閉癥整復外科治療
發(fā)布時間：2018-08-09 13:51
【摘要】：目的1基于三維數(shù)字化技術(shù),探索對顱縫早閉癥患者的骨組織、軟組織以及大腦容積的客觀測量方法,客觀定量化評價額眶前移的手術(shù)術(shù)式和療效。2基于三維數(shù)字化設計和制造技術(shù),根據(jù)術(shù)前手術(shù)模擬設計及導航導板,以期達到個性化精準顱頜面整復手術(shù)治療的目的。3建立顱縫早閉畸形三維有限元分析模型,分析畸形形成及顱眶截骨術(shù)后及模擬牽引的生物力學特征及變化,為內(nèi)置式牽引器的臨床應用奠定理論基礎。方法1選取2010年1月至2017年3月就醫(yī)手術(shù)的顱縫早閉癥患者12例,根據(jù)術(shù)前、術(shù)后、及隨訪時頭顱CT的DICOM數(shù)據(jù)重建頭顱的骨性、軟組織、腦組織結(jié)構(gòu),并進行定量化分析。2選取2014年8月至2016年12月就治于頜面整形外科中心的顱縫早閉癥患者3例,利用CT數(shù)據(jù)進行術(shù)前設計手術(shù)截骨方案,確定骨瓣復位位置,預制術(shù)中使用的復位導板并用于引導術(shù)中骨瓣的復位,比較各顱骨標志點術(shù)前術(shù)后的移動距離差,以及各標志點術(shù)前模擬情況及術(shù)后實際情況。3利用三維數(shù)字化技術(shù),進行顱縫早閉癥患兒的頭顱有限元建模,對顱縫早閉骨化畸形病理發(fā)生過程進行機制探討;對額眶前移術(shù)后的解剖結(jié)構(gòu)進行三維有限元生物力學分析,并在額眶前移截骨基礎上進行了牽引力模擬加載。結(jié)果1、顱底結(jié)構(gòu)患側(cè)與健側(cè)具有統(tǒng)計學差異:術(shù)前患側(cè)的前顱窩測量指標(CSX∧、CX、SX)以及中顱窩測量指標(XSM∧、S-Pt、XM、SM)隨訪時與術(shù)前有統(tǒng)計學差異。前顱對稱指數(shù),前顱窩偏斜角,額角,額面角,患側(cè)顳角,顳面角。術(shù)前大腦容積與對照組具有統(tǒng)計學差異指標;術(shù)后及隨訪時大腦容積與對照組無統(tǒng)計學差異;骨瓣前移變化測量:雙側(cè)額眶前移較單側(cè)額眶前移可以更好的使顳部向前外側(cè)方向擴展;單側(cè)額眶前移在糾正顳部畸形上效果不及雙側(cè)額骨瓣。2、利用三維打印的復位導板輔助術(shù)中骨瓣復位,縮短了手術(shù)時間,復位時間約為0.5小時至1小時;術(shù)中即刻直視下,額眶兩側(cè)對稱性形態(tài)相近;手術(shù)區(qū)域各標志點的術(shù)后與手術(shù)模擬之間的位移差效果類似。3、建立了 4節(jié)點一階四面體單元的頭顱三維有限元模型(靜態(tài)應力分析模型)、單側(cè)及雙側(cè)額眶前移截骨模擬有限元模型(荷載動態(tài)應力分析模型),通過應力分析結(jié)果顯示:在患側(cè)額部、左側(cè)顳部及左側(cè)頂部可見多個應力集中區(qū)域,提示患側(cè)額眶塌陷后縮的阻力來源于早閉骨化的冠狀縫;前顱窩及中顱窩的應力分布比較集中,提示骨化的冠狀縫及其向顱底延伸縫的早閉骨化所形成的阻力,導致前顱凹后縮淺小。而額眶前移模擬截骨有限元模型提示:我們所采用的手術(shù)術(shù)式可以解除阻力、降低顱底的應力,有利于顱底、頜面部在大腦、眼球生長推動力作用下,在三維空間上生長發(fā)育。在額部及顳部施加牽引力后,眼眶可出現(xiàn)向前向下的移位,得出最佳的牽引力大小及牽引距離。結(jié)論1、顱縫早閉癥患兒顱底、顱骨及顳部的骨組織及軟組織存在畸形,大腦容積低于正常,經(jīng)額眶前移術(shù)后畸形得到改善;雙側(cè)額眶前移較單側(cè)額眶前移更好改善顳部畸形。2、數(shù)字化技術(shù)輔助顱縫早閉癥的術(shù)前手術(shù)模擬,復位導板制作應用,可以提高手術(shù)精確性及安全性。3、建立了顱縫早閉癥的頭顱有限元模型及額眶前移模擬截骨有限元模型,可以了解畸形的病理發(fā)生機制;進行更加精細的手術(shù)模擬及安全的手術(shù);明確額眶前移對顱面和顱底形態(tài)及發(fā)育的影響,在額眶前移截骨基礎上進行牽引力模擬加載,優(yōu)化牽引方向及牽引力大小,為后期牽引器的設計奠定理論基礎。
[Abstract]:Objective 1 to explore the objective measurement of bone tissue, soft tissue and brain volume in patients with craniofacial early closure based on three-dimensional digital technology. Objective and objective quantitative evaluation of the surgical procedure and effect of frontal and orbital motion..2 based on three-dimensional digital design and manufacturing technology, according to pre operation simulation design and navigation guide plate, in order to achieve individualized precision. Objective.3 to establish a three-dimensional finite element analysis model of craniofacial early closure deformity for the objective of craniofacial reconstruction. The biomechanical characteristics and changes of the deformity formation and craniotomy and simulated traction were analyzed in order to lay a theoretical foundation for the clinical application of the built-in tractor. Method 1 the craniotomy early closure from January 2010 to March 2017 was selected. In 12 cases, 3 cases of craniotomy with craniotomy in maxillofacial plastic surgery center were selected from August 2014 to December 2016 by quantitative analysis of the bone, soft tissue, and brain structure of the skull based on the preoperative, postoperative, and DICOM data of the head CT, and the quantitative analysis of.2 was used to select the osteotomy program of the preoperative design and determine the bone with the CT data. The position of the reposition of the valve, the reduction guide plate used in prefabrication and the reduction of the bone flap in the operation, the difference of the moving distance between the cranial markers and the preoperative simulation and the actual situation after the operation, and the three-dimensional digital technique of.3 were used to make the craniofacial closure of the cranial seture. The mechanism of the pathological process of the deformity was discussed. The three-dimensional finite element biomechanical analysis of the anatomic structure after frontal orbital preshift was carried out and the traction simulated loading was carried out on the fronto orbital anterior truncation. Results 1, there were statistical differences between the affected side of the skull base and the healthy side: the measurement index of the anterior cranial fossa (CSX, CX, SX) before the operation. The median cranial fossa measurements (XSM, S-Pt, XM, SM) were statistically different from preoperative. Anterior cranial symmetry index, anterior cranial fossa skew angle, frontal angle, frontal angle, lateral temporal angle, temporal angle. The preoperative volume of brain was statistically different from that in control group; there was no statistical difference between the cerebral volume and the control group at the postoperative and follow-up; the changes of the anterior bone flap were measured: Bilateral frontal orbitoflobes move forward more laterally than unilateral frontal orbit. Unilateral frontal orbital anterior shift is less effective than bilateral frontal bone flap.2 for correcting temporomandibular malformation. The operation time is shortened from 0.5 hours to 1 hours with a three-dimensional printing reduction guide plate assisted operation, and the reduction time is about 0.5 hours to 1 hours. The symmetry of the frontal and orbital sides was similar; the effect of the displacement difference between the postoperatively and the surgical simulation was similar to.3. The three-dimensional finite element model (static stress analysis model) of the 4 node first order tetrahedron element (static stress analysis model), the finite element model of the unilateral and bilateral frontal orbital anterior shift osteotomy (dynamic stress analysis model) were established. The results of stress analysis showed that there were many stress concentration regions in the left temporal and left sides of the affected side, suggesting that the resistance of the lateral orbital collapse was derived from the coronary suture of the early closed ossification, and the stress distribution in the anterior and middle cranial fossa was concentrated, suggesting that the coronal suture of ossification and the early closure of the extension suture to the base of the skull were formed. The resistance of the anterior cranial fossa is small. The finite element model of the frontal orbital forward simulated osteotomy suggests that the operation method we adopt can relieve the resistance, reduce the stress of the skull base, be beneficial to the skull base, the maxillofacial growth and development under the action of the brain and the growth of the eyeball. After the traction force exerted on the forehead and the temporomandibular part, the orbit is applied. Conclusion 1, the skull base, the bone and the soft tissue in the skull and the temporomandibular part of the children with craniofacial early closure are deformed, the volume of the brain is lower than that of the normal, and the deformity of the brain is improved after the frontal orbital shift, and the bilateral frontal orbit moves better than the unilateral frontal orbit to improve the.2 of the temporomandibular malformation. The preoperative simulation of craniotomy for craniotomy and the application of the reduction guide can improve the accuracy and safety of the operation. The cranial finite element model of craniotomy and the frontal and orbital anterior shift simulated osteotomy finite element model can be established to understand the pathophysiological mechanism of the deformity, and to make more detailed surgical simulation and safety.3. The effect of frontal orbit movement on the shape and development of craniofacial and skull base was determined, and the traction force was simulated on the base of frontal and orbital anterior truncation, the direction of traction and the size of traction were optimized, which laid a theoretical foundation for the design of the later tractor.
【學位授予單位】：北京協(xié)和醫(yī)學院
【學位級別】：博士
【學位授予年份】：2017
【分類號】：R782.2
本文編號：2174270
[Abstract]:Objective 1 to explore the objective measurement of bone tissue, soft tissue and brain volume in patients with craniofacial early closure based on three-dimensional digital technology. Objective and objective quantitative evaluation of the surgical procedure and effect of frontal and orbital motion..2 based on three-dimensional digital design and manufacturing technology, according to pre operation simulation design and navigation guide plate, in order to achieve individualized precision. Objective.3 to establish a three-dimensional finite element analysis model of craniofacial early closure deformity for the objective of craniofacial reconstruction. The biomechanical characteristics and changes of the deformity formation and craniotomy and simulated traction were analyzed in order to lay a theoretical foundation for the clinical application of the built-in tractor. Method 1 the craniotomy early closure from January 2010 to March 2017 was selected. In 12 cases, 3 cases of craniotomy with craniotomy in maxillofacial plastic surgery center were selected from August 2014 to December 2016 by quantitative analysis of the bone, soft tissue, and brain structure of the skull based on the preoperative, postoperative, and DICOM data of the head CT, and the quantitative analysis of.2 was used to select the osteotomy program of the preoperative design and determine the bone with the CT data. The position of the reposition of the valve, the reduction guide plate used in prefabrication and the reduction of the bone flap in the operation, the difference of the moving distance between the cranial markers and the preoperative simulation and the actual situation after the operation, and the three-dimensional digital technique of.3 were used to make the craniofacial closure of the cranial seture. The mechanism of the pathological process of the deformity was discussed. The three-dimensional finite element biomechanical analysis of the anatomic structure after frontal orbital preshift was carried out and the traction simulated loading was carried out on the fronto orbital anterior truncation. Results 1, there were statistical differences between the affected side of the skull base and the healthy side: the measurement index of the anterior cranial fossa (CSX, CX, SX) before the operation. The median cranial fossa measurements (XSM, S-Pt, XM, SM) were statistically different from preoperative. Anterior cranial symmetry index, anterior cranial fossa skew angle, frontal angle, frontal angle, lateral temporal angle, temporal angle. The preoperative volume of brain was statistically different from that in control group; there was no statistical difference between the cerebral volume and the control group at the postoperative and follow-up; the changes of the anterior bone flap were measured: Bilateral frontal orbitoflobes move forward more laterally than unilateral frontal orbit. Unilateral frontal orbital anterior shift is less effective than bilateral frontal bone flap.2 for correcting temporomandibular malformation. The operation time is shortened from 0.5 hours to 1 hours with a three-dimensional printing reduction guide plate assisted operation, and the reduction time is about 0.5 hours to 1 hours. The symmetry of the frontal and orbital sides was similar; the effect of the displacement difference between the postoperatively and the surgical simulation was similar to.3. The three-dimensional finite element model (static stress analysis model) of the 4 node first order tetrahedron element (static stress analysis model), the finite element model of the unilateral and bilateral frontal orbital anterior shift osteotomy (dynamic stress analysis model) were established. The results of stress analysis showed that there were many stress concentration regions in the left temporal and left sides of the affected side, suggesting that the resistance of the lateral orbital collapse was derived from the coronary suture of the early closed ossification, and the stress distribution in the anterior and middle cranial fossa was concentrated, suggesting that the coronal suture of ossification and the early closure of the extension suture to the base of the skull were formed. The resistance of the anterior cranial fossa is small. The finite element model of the frontal orbital forward simulated osteotomy suggests that the operation method we adopt can relieve the resistance, reduce the stress of the skull base, be beneficial to the skull base, the maxillofacial growth and development under the action of the brain and the growth of the eyeball. After the traction force exerted on the forehead and the temporomandibular part, the orbit is applied. Conclusion 1, the skull base, the bone and the soft tissue in the skull and the temporomandibular part of the children with craniofacial early closure are deformed, the volume of the brain is lower than that of the normal, and the deformity of the brain is improved after the frontal orbital shift, and the bilateral frontal orbit moves better than the unilateral frontal orbit to improve the.2 of the temporomandibular malformation. The preoperative simulation of craniotomy for craniotomy and the application of the reduction guide can improve the accuracy and safety of the operation. The cranial finite element model of craniotomy and the frontal and orbital anterior shift simulated osteotomy finite element model can be established to understand the pathophysiological mechanism of the deformity, and to make more detailed surgical simulation and safety.3. The effect of frontal orbit movement on the shape and development of craniofacial and skull base was determined, and the traction force was simulated on the base of frontal and orbital anterior truncation, the direction of traction and the size of traction were optimized, which laid a theoretical foundation for the design of the later tractor.
【學位授予單位】：北京協(xié)和醫(yī)學院
【學位級別】：博士
【學位授予年份】：2017
【分類號】：R782.2
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