本文選題：唇腭裂 + 逆向工程技術(shù)　； 參考：《上海交通大學(xué)》2014年博士論文

【摘要】：目的 唇腭裂新生兒術(shù)前矯治是唇腭裂序列治療的組成環(huán)節(jié)之一，本研究以單側(cè)完全性唇腭裂新生兒為研究對象，使用逆向工程技術(shù)對傳統(tǒng)的術(shù)前矯治進(jìn)行優(yōu)化和改良，擬建立計(jì)算機(jī)輔助的術(shù)前鼻-牙槽骨塑形治療體系(CAD-NAM)，模擬治療目標(biāo)，輔助治療設(shè)計(jì)，采用快速成型技術(shù)對矯治器進(jìn)行個(gè)體化定制。準(zhǔn)確評價(jià)唇腭裂術(shù)后患者的顏面軟組織形態(tài)對了解手術(shù)改善鼻唇畸形作用的長期影響具有重要意義，雖然基于頭顱定位X線片的頭影測量可以在一定程度上獲得軟組織形態(tài)學(xué)信息，但是限于二維測量方法的局限性，尋求顏面軟組織形態(tài)的三維測量方法有助正畸醫(yī)師獲得更準(zhǔn)確的信息，為正畸診斷和治療設(shè)計(jì)提供良好的數(shù)據(jù)支持。本研究運(yùn)用立體照相技術(shù)獲取青春早期單側(cè)唇腭裂術(shù)后患者的顏面軟組織形態(tài)數(shù)據(jù)，基于逆向工程方法構(gòu)建顏面軟組織三維數(shù)字模型，評價(jià)顏面軟組織的非對稱畸形，探索鼻唇畸形的形態(tài)學(xué)規(guī)律。 病例和方法 1.單側(cè)完全性唇腭裂新生兒在監(jiān)護(hù)下制取上頜牙槽印模并翻制石膏模型，對石膏模型進(jìn)行三維激光掃描，使用Rapidform XOR3構(gòu)建三維數(shù)字模型并模擬CAD-NAM的最終治療目標(biāo)，計(jì)算牙槽各段的移動(dòng)距離，分解獲得治療全程各個(gè)分解步驟的上頜牙槽數(shù)字模型。 2.將各步驟數(shù)字模型導(dǎo)入快速原型設(shè)備進(jìn)行三維立體打印，制作分步驟工作模型，根據(jù)工作模型制作個(gè)體化成品CAD-NAM矯治器。術(shù)前矯治期間每次交付患者連續(xù)的4副矯治器，每1步驟的矯治器囑患者佩戴1周，每天佩戴20小時(shí)以上。當(dāng)上頜牙槽突裂裂隙寬度縮小至4mm時(shí)在矯治器上加裝鼻撐開始鼻翼塑形，該步驟矯治器持續(xù)佩戴至唇裂修復(fù)手術(shù)前，至此CAD-NAM治療全部完成。 3.收集單側(cè)完全性唇腭裂新生兒病例40例，治療組患者20例(男性16例，女性4例，初次就診平均年齡15.81天)，進(jìn)行CAD-NAM治療；對照組患者20例(男性15例，女性5例，初次就診平均年齡123.27天)，在唇裂修復(fù)手術(shù)前未行任何術(shù)前矯治。使用Rapdiform XOR3對兩組患者的上頜牙槽數(shù)字模型進(jìn)行形態(tài)學(xué)測量，使用SPSS15.0對兩組患者的測量數(shù)據(jù)進(jìn)行描述性統(tǒng)計(jì)分析，治療組在治療前后各測量指標(biāo)間做配對t檢驗(yàn)，在治療組治療后階段和對照組各測量指標(biāo)間做獨(dú)立樣本t檢驗(yàn)。 4.收集單側(cè)完全性唇腭裂伴牙槽突裂的青少年病例20例作為病例組(男性12例，女性8例，初次就診時(shí)平均年齡11.82歲)；收集非裂健康青少年20例作為對照組(男性10例，女性10例，平均年齡12.00歲)。使用Axis Three’s3D Simulation Platform立體照相設(shè)備構(gòu)建顏面軟組織三維數(shù)字模型。 5.使用Rapidform XOR3對顏面軟組織三維數(shù)字模型進(jìn)行線距和角度測量，，使用SPSS15.0對所得數(shù)據(jù)進(jìn)行描述性統(tǒng)計(jì)學(xué)分析，在兩組各測量指標(biāo)間做獨(dú)立樣本t檢驗(yàn)，在病例組的面部雙側(cè)測量指標(biāo)間做配對t檢驗(yàn)，在各組內(nèi)部對涉及鼻孔、鼻翼和上唇的測量指標(biāo)做皮爾森相關(guān)系數(shù)分析。 6.使用Geomagic Qualify11.0對單側(cè)唇腭裂伴牙槽突裂術(shù)后患者的顏面軟組織數(shù)字模型做鏡像分析和檢測，將顏面影像圍繞正中矢狀面做水平翻轉(zhuǎn)，使左右半側(cè)顏面的影像重疊生成距離映射圖，在距離映射圖上觀測和評價(jià)顏面軟組織非對稱畸形的嚴(yán)重程度和分布。 結(jié)果 1.單側(cè)完全性唇腭裂新生兒在CAD-NAM治療前后各測量指標(biāo)的配對t檢驗(yàn)結(jié)果提示在水平方向，唇裂裂隙寬度和上頜中線偏斜量等指標(biāo)在治療前后的差異具有顯著統(tǒng)計(jì)學(xué)意義，在矢狀方向牙弓長度等指標(biāo)在治療前后的差異具有統(tǒng)計(jì)學(xué)意義，在垂直方向乳切牙和乳尖牙區(qū)域的牙槽突垂直高度在治療前后的差異具有顯著統(tǒng)計(jì)學(xué)意義。 2. CAD-NAM治療組治療后和對照組在唇裂修復(fù)術(shù)前各測量指標(biāo)的獨(dú)立樣本t檢驗(yàn)結(jié)果提示在水平方向唇裂裂隙寬度和上頜中線偏斜量等指標(biāo)在兩組間的差異具有顯著統(tǒng)計(jì)學(xué)意義，在矢狀方向牙弓長度等指標(biāo)在兩組間的差異具有統(tǒng)計(jì)學(xué)意義，在垂直方向乳切牙和乳尖牙區(qū)域的牙槽突垂直高度在兩組間的差異具有顯著統(tǒng)計(jì)學(xué)意義。 3.青春早期單側(cè)唇腭裂術(shù)后患者顏面軟組織形態(tài)測量結(jié)果提示病例組和正常對照組在鼻孔、鼻翼、鼻小柱和上唇人中等部位的測量數(shù)據(jù)的組間差異具有顯著統(tǒng)計(jì)學(xué)意義。 4.顏面軟組織鏡像分析結(jié)果提示在距離映射圖上的任意點(diǎn)都可以計(jì)算得出左右半側(cè)顏面矢狀向距離差值。青春早期單側(cè)唇腭裂術(shù)后患者面部軟組織的不對稱區(qū)域集中在鼻翼、鼻小柱、上唇和頦部。 結(jié)論 1. CAD-NAM是一種有效的唇腭裂新生兒術(shù)前矯治系統(tǒng)，能夠?qū)崿F(xiàn)精確量化的上頜牙槽骨塊移動(dòng)，節(jié)省正畸醫(yī)師在患者復(fù)診時(shí)的椅旁操作時(shí)間。 2.對于畸形程度較重的病例CAD-MAN可以有效糾正上頜牙槽形態(tài)，使明顯前突的牙槽骨前段回納至正常位置，糾正上頜牙槽中線，縮小牙槽突裂裂隙寬度。 3.但是CAD-NAM可能導(dǎo)致治療后牙槽高度降低。后續(xù)研究將致力于探索CAD-NAM對鼻唇軟組織畸形的塑形作用和術(shù)前矯治對唇腭裂新生兒上頜牙槽和鼻唇軟組織生長發(fā)育的長期影響。 4.單側(cè)唇腭裂術(shù)后患者在青春早期仍表現(xiàn)出較非裂正常人群更嚴(yán)重的面部軟組織不對稱，組織畸形集中在鼻唇區(qū)域，提示唇腭裂修復(fù)手術(shù)對鼻唇軟組織對稱性的改善有限，仍需后期進(jìn)一步整復(fù)。 5.基于立體照相建立的顏面軟組織分析方法因無損傷且可重復(fù)的優(yōu)點(diǎn)可以在治療過程中實(shí)現(xiàn)動(dòng)態(tài)追蹤，使醫(yī)生能夠及時(shí)了解患者顏面軟組織的形態(tài)變化，距離映射圖檢測方法可以便捷直觀地顯示面部不對稱的區(qū)域分布和嚴(yán)重程度，包括定性判斷和定量計(jì)算兩方面信息，為后續(xù)正畸診斷和治療設(shè)計(jì)提供數(shù)據(jù)支持。
[Abstract]:objective
Treatment of newborns with cleft lip and palate before surgery is one of the components of cleft lip and palate team approach, this study takes unilateral cleft lip and palate newborns as the research object, for optimizing and improving the traditional preoperative use of reverse engineering technology, to establish the computer aided preoperative nasal bone remodeling treatment system (CAD-NAM), simulation the treatment goal, adjuvant treatment design, individualized customization of appliance by rapid prototyping technology. The accurate evaluation of cleft lip and palate patients with facial soft tissue morphology to understand the long-term effects of surgery to improve nasolabial deformity effect has important significance, although the cephalometric skull X-ray localization can be obtained soft tissue morphological information in a certain degree based on the limitations but limited to 2D measurement method, 3D measurement method for facial soft tissue morphology can help orthodontists to obtain more accurate information for it The diagnosis and treatment of abnormal design provides a good data support. This research uses stereo camera technology to obtain early puberty in cleft lip and palate patients with facial soft tissue morphological data, construct soft tissue three-dimensional digital model of reverse engineering method based on the asymmetric evaluation of facial soft tissue deformity, morphological features of cleft lip nose exploration.
Cases and methods
1. unilateral cleft lip and palate produced in the neonatal care and turning the maxillary alveolar impression plaster model, 3D laser scanning on the plaster model, a final goal of treatment using Rapidform XOR3 to build the 3D digital model and CAD-NAM simulation of the moving distance calculation of alveolar segments, decomposition of maxillary alveolar digital model treatment throughout each decomposition step.
2. rapid prototyping equipment in the procedure of digital models into 3D printing, making steps work model, according to the working model of the production of individual products CAD-NAM appliance. Preoperative treatment of every period of delivery in 4 side appliance continuous, every 1 steps of the appliance Huanzhe wear 1 weeks, every day wearing more than 20 hours. When the nose is added in the appliance on the maxillary alveolar cleft fissure width shrink to 4mm support to the nose shaping step appliance worn continuously to cleft lip repair surgery, so CAD-NAM treatment was completed.
3. collection of unilateral cleft lip and palate newborns 40 cases, 20 cases of patients in the treatment group (16 cases, 4 cases of male and female first visit an average age of 15.81 days), CAD-NAM treatment; 20 cases of the control group (15 cases, 5 cases of male and female first visit an average age of 123.27 days), without any preoperative correction of cleft lip repair before the operation. The use of Rapdiform XOR3 maxillary alveolar digital model of two groups of patients were measured, using the SPSS15.0 measurement data of two groups of patients were analyzed by descriptive statistical analysis, the treatment group paired t test before and after the treatment of each measurement, in the treatment group and the control group of each measurement stage do independent samples t test.
4. collection of unilateral cleft lip and palate with cleft teenagers in 20 cases as case group (12 cases, 8 cases of male and female first visit an average age of 11.82); collection of non split healthy adolescents in 20 cases as control group (10 cases, 10 cases of male and female with an average age of 12 years) with Axis. Three 's3D Simulation Platform stereo camera equipment to build a three-dimensional digital model of facial soft tissue.
5. using Rapidform XOR3 on facial soft tissue three-dimensional digital model of line distance and angle measurement, using SPSS15.0 descriptive statistical analysis of the obtained data, independent samples t test in two groups of indicators, paired t test in bilateral facial measurement index case group, in each group to measure the internal nostril. The nose and upper lip of the Pearson correlation coefficient.
6. using Geomagic Qualify11.0 for unilateral cleft lip and palate alveolar cleft with postoperative facial soft tissue digital model of patients with image analysis and detection, the facial image around the horizontal flip midsagittal plane, left and right half facial image overlapping generation distance map, observation distance mapping and evaluation of facial soft tissue the severity and distribution of symmetric deformity.
Result
1. unilateral cleft lip and palate neonatal outcome of paired t test in CAD-NAM before and after treatment of each measurement tips in the horizontal direction, the index of cleft lip fracture width and maxillary midline deviation has significant differences in before and after treatment, in the sagittal direction and length of the dental arch were statistically significant differences in before and after treatment, in the vertical the height of alveolar vertical and deciduous incisor region in deciduous teeth difference before and after treatment were statistically significant.
2. CAD-NAM after treatment in the treatment group and the control group in the cleft lip repair before the measurement index of independent samples t test results indicate that the differences in the index of horizontal cleft lip fracture width and maxillary midline deviation in between the two groups was statistically significant in the sagittal direction, the arch length index is the difference between the two groups statistical significance, in the vertical height of alveolar vertical direction and the deciduous incisor deciduous canine regional differences among the two groups was statistically significant.
3. early puberty in cleft lip and palate patients with facial soft tissue morphometry results suggest that patient group and normal control group in the nose, nose, there was a statistically significant difference measurement data of the columella secondary parts of the group.
4. soft tissue image analysis showed that in the distance of any point on the map can be calculated about semifacial sagittal distance difference. The asymmetric Regional Youth early cleft lip and palate patients with facial soft tissue in the nasal columella, upper lip and chin.
conclusion
1. CAD-NAM is an effective pre-operative orthodontic system for cleft lip and palate neonates. It can achieve precise quantification of alveolar bone movement in the maxilla and save time for orthodontic doctors when they return to the clinic.
2., for the cases with severe deformity, CAD-MAN can effectively correct the maxillary alveolar morphology, make the anterior segment of the anterior alveolar bone return to the normal position, correct the upper alveolar midline and reduce the width of the alveolar cleft.
3., however, CAD-NAM may lead to decreased alveolar height after treatment. Follow-up studies will explore the long-term effect of CAD-NAM on the growth and development of maxillary alveolar and nasolabial soft tissues in patients with cleft lip and palate.
4. patients with unilateral cleft lip and palate still showed more severe facial soft tissue asymmetry in early puberty than normal subjects. The tissue deformity was concentrated in the nasolabial region, suggesting that the repair of lip and palate is limited to the improvement of the symmetry of the nasolabial soft tissue, and it still needs further restitution.
5. soft tissue based on the analysis method of stereoscopic photography because of the advantages of no injury and repeatable can realize dynamic tracking in the treatment process, so that doctors can timely understand the morphological changes in patients with facial soft tissue, distance map detection method can be convenient to visually display the regional distribution of facial asymmetry and severity, including qualitative judgment and quantitative analysis of two aspects of information, provide data support for the subsequent orthodontic diagnosis and treatment design.

【學(xué)位授予單位】：上海交通大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R782.2

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