發(fā)布時(shí)間：2018-04-25 01:05

  本文選題：L型顴骨截骨降低術(shù) + 數(shù)字化技術(shù)��； 參考：《北京協(xié)和醫(yī)學(xué)院》2015年博士論文

【摘要】：目的1.應(yīng)用整形外科最普遍醫(yī)學(xué)圖像資料——數(shù)字化照片對(duì)行L型顴骨截骨降低術(shù)患者手術(shù)前術(shù)后顴部輪廓變化進(jìn)行客觀定量的測(cè)量分析。2.分別對(duì)三維CT重建圖像及二維CT斷層圖像進(jìn)行測(cè)量,探索和總結(jié)L型顴骨截骨降低術(shù)后顱頜面骨性結(jié)構(gòu)的變化。3.應(yīng)用數(shù)字化外科技術(shù)輔助單側(cè)顴骨L型截骨降低術(shù)用以矯正顴骨不對(duì)稱(chēng)畸形,提高手術(shù)的精確性及安全性。方法1.標(biāo)準(zhǔn)化采集受試者數(shù)字化照片,提出顴部輪廓測(cè)量評(píng)價(jià)方法并測(cè)量高顴骨患者術(shù)前術(shù)后及正常貌美人群相關(guān)數(shù)據(jù),客觀定量評(píng)價(jià)L型顴骨截骨降低術(shù)后顴部輪廓的變化。2.運(yùn)用人體測(cè)量學(xué)的相關(guān)原理分別對(duì)高顴骨患者的術(shù)前術(shù)后三維CT重建圖像以及斷層CT影像進(jìn)行測(cè)量分析,研究L型顴骨截骨降低術(shù)前后顴骨相關(guān)寬度、突度、角度和比例等顱頜面骨性參數(shù)的變化。3.運(yùn)用數(shù)字化外科技術(shù),對(duì)雙側(cè)顴骨不對(duì)稱(chēng)患者的影像學(xué)數(shù)據(jù)進(jìn)行三維重建、在數(shù)字化外科平臺(tái)上進(jìn)行個(gè)性化的手術(shù)設(shè)計(jì)和模擬,制作快速成型手術(shù)導(dǎo)板指導(dǎo)術(shù)中精確截骨,并評(píng)估術(shù)后效果。結(jié)果1.通過(guò)高顴骨患者的術(shù)前術(shù)后斜側(cè)面照片的測(cè)量分析顯示：平均顴突值術(shù)后有顯著的降低并接近正常貌美組人群數(shù)值,而顴高值并無(wú)明顯變化。顴骨降低術(shù)后患者容貌值有顯著提高。2.通過(guò)計(jì)算機(jī)輔助技術(shù)對(duì)L型顴骨截骨降低術(shù)前后三維CT重建圖像及二維斷層影像進(jìn)行測(cè)量分析發(fā)現(xiàn)：顴骨L型截骨降低術(shù)后顴骨顴弓復(fù)合體突度、寬度以及角度等參數(shù)都得到明顯的改善,顴骨與顱頜面相關(guān)骨性比例變得更加協(xié)調(diào)。顴弓寬度從根部向前方變化量逐漸增大,于顴弓前2/3部分開(kāi)始變得顯著。3.通過(guò)數(shù)字化外科和快速成型技術(shù)輔助單側(cè)L型顴骨截骨降低術(shù)矯正顴骨不對(duì)稱(chēng)畸形,患者雙側(cè)顴骨不對(duì)稱(chēng)均得到矯正,并未出現(xiàn)并發(fā)癥。術(shù)后三維重建模型和術(shù)前設(shè)計(jì)模型配比和差值分析結(jié)果顯示出微小的差異。結(jié)論1.本研究創(chuàng)新地提出了簡(jiǎn)單、直觀的應(yīng)用數(shù)字化照片測(cè)量評(píng)估顴部輪廓的分析方法。顴骨L型截骨降低術(shù)可以顯著地降低顴突點(diǎn)突度,并不造成明顯的顴突點(diǎn)下移,手術(shù)美學(xué)效果好。2.通過(guò)對(duì)高顴骨患者手術(shù)前后二維及三維CT測(cè)量研究發(fā)現(xiàn)：L型顴骨截骨降低術(shù)后顴骨顴弓復(fù)合體寬度、突度、以及角度等參數(shù)都得到明顯地改善,顴骨與顱頜面相關(guān)骨性比例變得更加協(xié)調(diào)。顴骨L型截骨降低術(shù)最佳適應(yīng)征為：顴骨體突出伴或不伴顴弓前部突出患者。3.應(yīng)用數(shù)字化外科技術(shù)及快速成型技術(shù)輔助單側(cè)顴骨L型截骨降低術(shù)矯正顴骨不對(duì)稱(chēng)畸形,可以進(jìn)行術(shù)前設(shè)計(jì)和模擬截骨,設(shè)計(jì)最佳手術(shù)方案,制備快速成型手術(shù)導(dǎo)板指導(dǎo)術(shù)中精確截骨,可有效地提高手術(shù)精確性并減少風(fēng)險(xiǎn)。
[Abstract]:Objective 1. The most common medical image data of plastic surgery, digital photograph, were used to measure and analyze the profile of zygomatic region in patients with L-type zygomatic osteotomy before and after operation. Three-dimensional CT reconstruction images and two-dimensional CT tomography images were measured to explore and summarize L-type zygomatic osteotomy to reduce the changes of craniofacial bone structure. Digital surgical technique was used to improve the accuracy and safety of unilateral L-type osteotomy for correction of asymmetric malformation of zygomatic bone. Method 1. The digital photographs of subjects were collected, and the evaluation method of zygomatic contour was put forward, and the relative data of pre-and post-operative and normal persons with high zygomatic bone were measured, and the changes of zygomatic contour after L-type zygomatic osteotomy were evaluated objectively and quantitatively. The correlation principle of anthropometry was used to measure and analyze the preoperative and postoperative 3D CT reconstruction images and tomographic CT images of patients with high zygomatic bone, and to study the reduction of the width and protrusion of zygomatic bone before and after L-type zygomatic osteotomy. Angle and ratio of craniomaxillofacial bone parameters change. 3. The digital surgical technique was used to reconstruct the imaging data of bilateral zygomatic asymmetry patients. The individualized surgical design and simulation were carried out on the digital surgical platform, and the rapid prototyping guide plate was made to guide the accurate osteotomy during the operation. The effect of operation was evaluated. Result 1. The results showed that the mean zygomatic process value was significantly decreased after operation and was close to that in the normal group, but there was no significant change in the zygomatic height value in the patients with high zygomatic bone. The value of facial appearance in patients with lower zygomatic bone after operation was significantly increased by. 2. 2. Three-dimensional CT reconstruction images and two-dimensional tomographic images before and after L-shaped zygomatic osteotomy were measured and analyzed by computer-aided technique. The results showed that L-type zygomatic osteotomy reduced the degree of zygomatic arch complex after operation. The parameters such as width and angle were improved obviously, and the ratio of zygomatic bone and craniofacial bone became more harmonious. The width of zygomatic arch increased gradually from the root to the front, and began to become significant at the third third of the front of the zygomatic arch. Digital surgery and rapid prototyping were used to assist unilateral L-shaped zygomatic osteotomy to correct asymmetric malformation of zygomatic bone. The bilateral asymmetry of zygomatic bone was corrected without complication. The results of three-dimensional reconstruction model and pre-operative design model showed slight difference. Conclusion 1. In this study, a simple and intuitionistic analysis method of zygomatic profile was proposed. L-type zygomatic osteotomy can significantly reduce the zygomatic process point protrusion, and does not cause obvious zygomatic process point downward shift, the aesthetic effect of the operation is good. 2. Two-dimensional and three-dimensional CT measurements before and after surgery in patients with high zygomatic bone showed that the width, protuberance, and angle of zygomatic arch complex were significantly improved after surgery. The ratio of zygomatic bone to craniofacial bone became more harmonious. The best adaptation sign of L-type osteotomy was: zygomatic body protrusion with or without anterior zygomatic arch protrusion. Digital surgical technique and rapid prototyping technique were used to assist unilateral L-type osteotomy to correct asymmetric malformation of zygomatic bone, which could be used to design and simulate osteotomy before operation and to design the best operative scheme. The preparation of rapid prototyping guide plate can effectively improve the accuracy and reduce the risk of operative osteotomy.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R782.2

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