【摘要】：目的1建立適合半側(cè)顏面短小畸形骨組織與軟組織三維測(cè)量方法,利用三維CT影像學(xué)數(shù)據(jù)及面部三維掃描數(shù)據(jù),對(duì)其顱面部骨組織及軟組織畸形進(jìn)行定量化評(píng)估,分析其面部不對(duì)稱畸形的形態(tài)學(xué)特點(diǎn)。2探討在數(shù)字化技術(shù)的輔助下,應(yīng)用聯(lián)合下頜升支矢狀劈開(kāi)截骨術(shù)的改良式牽引成骨技術(shù),治療半側(cè)顏面短小畸形的方法及臨床效果。3利用創(chuàng)建的硬軟組織三維測(cè)量方法,對(duì)半側(cè)顏面短小畸形患者改良式牽引成骨術(shù)前后的軟硬組織變化情況進(jìn)行測(cè)量分析,定量化評(píng)估手術(shù)效果。方法選擇2013年6月至2015年10月間于中國(guó)醫(yī)學(xué)科學(xué)院整形外科醫(yī)院頜面整形外科中心進(jìn)行治療的半側(cè)顏面短小畸形患者10例。1利用半側(cè)顏面短小畸形患者的CT數(shù)據(jù)及面部三維掃描數(shù)據(jù),分別在MIMCS軟件中建立骨組織及軟組織三維測(cè)量坐標(biāo)系,標(biāo)記各個(gè)解剖標(biāo)志點(diǎn),進(jìn)行健側(cè)患側(cè)精確的定量化分析,了解其面部不對(duì)稱畸形的形態(tài)特征,并利用此方法進(jìn)行術(shù)前評(píng)估。2術(shù)前將CT數(shù)據(jù)三維重建出骨組織模型,標(biāo)記出下牙槽神經(jīng)管的走向及牙胚的位置,并以此為依據(jù)精確設(shè)計(jì)手術(shù)截骨方案,根據(jù)健側(cè)患側(cè)下頜骨不對(duì)稱情況設(shè)計(jì)牽引延長(zhǎng)的距離和方向,用于指導(dǎo)手術(shù)。術(shù)中使用結(jié)合下頜升支矢裝劈開(kāi)截骨術(shù)的改良式牽引成骨術(shù)進(jìn)行截骨,以保護(hù)患者下牙槽神經(jīng)、血管及牙胚,進(jìn)一步提升手術(shù)安全性及效果。術(shù)后行快速牽引,延長(zhǎng)短小的下頜骨,改善面部不對(duì)稱畸形。3利用我們建立的三維測(cè)量方法,對(duì)半側(cè)顏面短小畸形患者術(shù)前術(shù)后的三維CT及面部掃描數(shù)據(jù)進(jìn)行對(duì)比分析,計(jì)算各標(biāo)志點(diǎn)的變化情況,并計(jì)算下頜升支高度等重要線距的變化情況,以定量化分析改良式牽引成骨術(shù)對(duì)半側(cè)顏面短小畸形骨組織及軟組織不對(duì)稱的改善情況。結(jié)果1建立出三維測(cè)量方法,并對(duì)10例患者進(jìn)行面部軟組織畸形分析,初步探討半側(cè)顏面短小畸形軟組織畸形的形態(tài)學(xué)特征,面部軟組織畸形是三維方向的不對(duì)稱畸形,多個(gè)軸向均存在不對(duì)稱。上面部的軟組織結(jié)構(gòu)不對(duì)稱畸形較輕,下面部的軟組織不對(duì)稱畸形較重,中面部接近中線的部位畸形程度較輕。2利用基于數(shù)字化技術(shù)的改良式牽引成骨術(shù)矯治10例半側(cè)顏面短小畸形患者,未發(fā)生嚴(yán)重并發(fā)癥,有效保護(hù)了重要血管、神經(jīng)及牙胚結(jié)構(gòu),術(shù)后面不對(duì)稱性獲得了明顯改善,咬合平面趨于水平,效果滿意。3術(shù)后患側(cè)下頜升支長(zhǎng)度由35.9±3.85mm延長(zhǎng)至44.85±5.05mm,厚度由8.29±1.OOmm增加至10.08+1.64mm,雙側(cè)下頜升支不對(duì)稱率由30.30%±4.80%降低至13.27%±5.60%,頦下點(diǎn)至面中線的距離由13.19±3.52mm降至5.61±2.67mm,患側(cè)面部口角至外眥間距離由62.93±5.61mm增加至65.92±5.84mm,患側(cè)口角至耳屏間距離由77.58±9.34mm增加至82.224±10.71mm,結(jié)果具有統(tǒng)計(jì)學(xué)意義。面部骨組織及軟組織的對(duì)稱性獲得了明顯改善。結(jié)論1三維測(cè)量方法準(zhǔn)確可靠,可以用于半側(cè)顏面短小畸形對(duì)稱性的分析及手術(shù)方案的制定,初步探討了軟組織不對(duì)稱畸形的三維測(cè)量方法,同時(shí)適用于其他顱頜面畸形和相關(guān)美學(xué)研究,值得進(jìn)一步探討。2應(yīng)用下頜升支矢狀劈開(kāi)截骨行牽引成骨技術(shù),增加了骨接觸面積,能加快牽引速率,縮短療程,提高手術(shù)安全性,并發(fā)癥少,能有效矯治半側(cè)顏面短小畸形的頜骨不對(duì)稱。3應(yīng)用三維測(cè)量方法對(duì)改良式牽引成骨術(shù)后效果進(jìn)行定量化評(píng)價(jià),證實(shí)其治療效果明確,可明顯改善骨組織及軟組織的不對(duì)稱畸形,結(jié)果真實(shí)可靠。利用三維測(cè)量方法可以對(duì)半側(cè)顏面短小畸形進(jìn)行療效評(píng)估,同時(shí)適用于其他畸形的療效分析研究,適用性廣,可以臨床推廣使用。
[Abstract]:Objective 1. To establish a three-dimensional measurement method for the bone and soft tissue of hemifacial micromalformation, and to quantitatively evaluate the skull and soft tissue deformities of hemifacial micromalformation by using three-dimensional CT imaging data and facial three-dimensional scanning data, and to analyze the morphological characteristics of facial asymmetric deformities. 2. To explore the application of digital technology. Methods and clinical effects of modified distraction osteogenesis combined with sagittal ramus osteotomy in the treatment of hemifacial microdeformity. 3 The changes of soft and hard tissues in hemifacial microdeformity patients before and after modified distraction osteogenesis were measured and analyzed by using the established three-dimensional measurement method of hard and soft tissue. Methods From June 2013 to October 2015, 10 patients with hemifacial microdeformity were selected from the Center of Maxillofacial Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences. Dimensional coordinate system was used to mark the anatomical landmarks, and quantitative analysis was performed on the affected side of the healthy side to understand the morphological characteristics of facial asymmetry deformity. 2 The bone tissue model was reconstructed from CT data before operation, and the orientation of the inferior alveolar canal and the position of the tooth germ were marked. The modified distraction osteogenesis combined with sagittal split ramus osteotomy was used to protect the inferior alveolar nerve, blood vessel and tooth germ, and to further enhance the safety and safety of the operation. Results. Rapid traction was used to lengthen the short mandible and improve the facial asymmetry. 3 The three-dimensional CT and facial scan data of the patients with hemifacial microdeformity were compared and analyzed by using the three-dimensional measurement method established by us. The changes of each landmark were calculated, and the height of mandibular ramus and other important line spacing were calculated. Results 1 A three-dimensional measurement method was established and 10 cases of facial soft tissue deformities were analyzed. The morphological characteristics, facial soft tissue deformities and soft tissue deformities of hemifacial short deformities were preliminarily discussed. Deformity is a three-dimensional asymmetric deformity with asymmetry in many axes. Soft tissue structural asymmetry in the upper part is lighter, soft tissue asymmetry in the lower part is heavier, and deformity in the middle face is lighter. 2 Modified traction osteogenesis based on digital technology was used to correct 10 cases of hemifacial short deformity. No serious complications occurred in the patients with M-shaped mandibular fracture. The facial asymmetry was significantly improved and the occlusal plane was level. The length of the affected mandibular ramus was increased from 35.9 (+ 3.85) mm to 44.85 (+ 5.05) mm. The thickness of the ramus increased from 8.29 (+ 1.OOmm) to 10.08 (+ 1.64) mm. The symmetry rate was reduced from 30.30%+4.80% to 13.27%+5.60%, the distance from the submental point to the midline of the face was reduced from 13.19%+3.52 mm to 5.61%+2.67 mm, the distance from the angle of mouth to the epicanthus was increased from 62.93%+5.61 mm to 65.92%+5.84 mm, and the distance from the angle of mouth to the tragus was increased from 77.58+9.34 mm to 82.224+10.71 mm in the facial bone group. The symmetry of tissue and soft tissue was improved obviously. Conclusion 1 The three-dimensional measurement method is accurate and reliable, and can be used to analyze the symmetry of hemifacial micromalformation and to make the operation plan. The three-dimensional measurement method of soft tissue asymmetry is preliminarily discussed. It is also suitable for other craniomaxillofacial deformities and related aesthetic research. Step 2. Sagittal split ramus osteotomy for distraction osteogenesis can increase the area of bone contact, speed up the distraction rate, shorten the course of treatment, improve the safety of operation, reduce complications, and effectively correct the jaw asymmetry of hemifacial short deformity. 3. Quantitative evaluation of the effect of modified distraction osteogenesis by three-dimensional measurement method The results showed that the treatment effect was definite, and the asymmetric deformity of bone and soft tissue could be improved obviously. The three-dimensional measurement method could be used to evaluate the curative effect of hemifacial microdeformity, and it was also suitable for the analysis of the curative effect of other deformities.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R782

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