數(shù)字化截骨導板在下頜角截骨術(shù)中的應(yīng)用研究
發(fā)布時間：2019-05-06 09:53
【摘要】：目的：下頜角弧形截骨術(shù)是頜面外科常見的美容手術(shù)之一,目前術(shù)者對雙側(cè)截骨線的設(shè)計大多是通過術(shù)前閱片(X光片+CT)以及計算機軟件測量設(shè)計并進行手術(shù)效果模擬來實現(xiàn)的,但怎樣將術(shù)前設(shè)計的手術(shù)方案及各個測量數(shù)據(jù)精確地復(fù)制到術(shù)中患者的下頜骨上一直是一個難題。再加上本手術(shù)操作視野狹小,術(shù)者很難對術(shù)區(qū)獲得有效的三維視覺,進而對截骨線的設(shè)計單憑經(jīng)驗而有失精確性。本研究將借助于計算機軟件三維設(shè)計、3D打印等數(shù)字化技術(shù),術(shù)前在計算機三維模型上精確設(shè)計截骨線,并通過計算機軟件沿截骨線設(shè)計制作能夠與下頜角區(qū)骨質(zhì)的三維形態(tài)完全匹配的數(shù)字化截骨導板,再將這些導板數(shù)據(jù)通過3D打印技術(shù)打印出實體導板,術(shù)中置入術(shù)區(qū)指導截骨,從而提高手術(shù)的精確性和對稱性,縮短手術(shù)時間,并降低手術(shù)并發(fā)癥的發(fā)生率 方法：第一部分確定導板置入術(shù)區(qū)的可行性：首先將患者的CT數(shù)據(jù)轉(zhuǎn)化為STL格式文件,并導入3D打印機(Z-printer350)打印下頜骨3D模型。再將患者的CT資料轉(zhuǎn)入ProPlan軟件中,在計算機中重建下頜骨三維模型,在虛擬三維模型上設(shè)計截骨線,并對各個標志點進行測量,再根據(jù)測量的數(shù)據(jù)將截骨線標記到打印的下頜骨3D模型上,將自凝樹脂沿標記的截骨線捏合于模型上制作截骨導板。定型后取下,術(shù)中2%碘酒浸泡消毒后置入術(shù)區(qū)。本部分研究將確定不同類型的下頜角所對應(yīng)的截骨導板的不同形態(tài),并驗證不同導板置入術(shù)區(qū)的可行性。第二部分通過ProPlan軟件在虛擬三維模型上設(shè)計截骨線,再將截骨數(shù)據(jù)以STL文件形式導入GeoMagic軟件,設(shè)計數(shù)字化截骨導板,最后以通過FDA認證的聚乳酸(PLA)材料打印截骨導板,術(shù)中植入術(shù)區(qū)完成臨床應(yīng)用。 結(jié)果：針對不同類型的下頜角肥大患者設(shè)計不同的截骨方式,再據(jù)此確定不同類型的個性化截骨導板,導板形態(tài)適合置入術(shù)區(qū)。導板能夠與術(shù)區(qū)骨質(zhì)緊密貼合,穩(wěn)定性好,截除的下頜角與截骨導板匹配度高。所有患者(第一部分10例,第二部分5例)術(shù)后效果均與術(shù)前設(shè)計一致,術(shù)中未出現(xiàn)骨折、大出血、感染等并發(fā)癥,術(shù)后測量雙側(cè)下頜骨對稱性良好。 結(jié)論：本研究通過數(shù)字化截骨導板將術(shù)前的設(shè)計數(shù)據(jù)準確的復(fù)制到術(shù)區(qū)骨骼,術(shù)者在導板的指引下能夠準確的完成截骨,大大的提高了手術(shù)的精確性和對稱性,實現(xiàn)了下頜角截骨手術(shù)從經(jīng)驗論到數(shù)字化的轉(zhuǎn)化,并簡化了下頜角截骨術(shù)式,制定的標準化治療模式對臨床工作具有重大的指導意義。
[Abstract]:Objective: mandibular angle arc osteotomy is one of the common cosmetic operations in maxillofacial surgery. At present, the design of bilateral osteotomy line is mostly achieved by preoperative X-ray reading (CT) and computer software measurement design and surgical effect simulation. However, it has been a difficult problem how to accurately copy the preoperative surgical scheme and the measured data to the mandible of the patients during the operation. In addition, it is difficult for the operator to obtain an effective 3-D vision of the operation area, and then the design of the osteotomy line is less accurate based on the experience. In this study, the computer software 3D design, 3D printing and other digital technology will be used to accurately design the osteotomy line on the computer three-dimensional model before the operation. Through the computer software along the osteotomy line, a digital osteotomy guide plate which can match the three-dimensional shape of the mandible angle bone is designed and made. Then the data of the guide plate is printed out by the 3D printing technology, and the osteotomy is guided in the operation area. In order to improve the accuracy and symmetry of the operation, shorten the operation time, and reduce the incidence of complications methods: part one to determine the feasibility of inserting the guide plate into the operation area: first, convert the patient's CT data into the STL format file. And import a 3D printer (Z-printer350) to print a 3D model of the mandible. Then the CT data of the patients were transferred into the ProPlan software to reconstruct the three-dimensional model of the mandible in the computer, design the osteotomy line on the virtual three-dimensional model, and measure the mark points. According to the measured data, the osteotomy line was labeled on the printed 3D model of mandible, and the autocoagulation resin was kneaded along the labeled osteotomy line to make the osteotomy guide plate. After shaping, 2% iodine wine was soaked and sterilized and placed into the operation area. This study will determine the different shape of osteotomy guide plate corresponding to different mandibular angle and verify the feasibility of inserting different guide plate into the operation area. The second part designs the osteotomy line on the virtual three-dimensional model by the ProPlan software, then imports the osteotomy data into the GeoMagic software in the form of STL file, designs the digital osteotomy guide board, and finally prints the osteotomy guide board with the FDA-certified polylactic acid (PLA) material. The clinical application of intraoperative implantation was completed. Results: different osteotomy methods were designed for patients with different types of mandibular angle hypertrophy, and then different types of individualized osteotomy guide plates were determined. The shape of the guide plates was suitable for insertion into the operation area. The guide plate can fit closely with the bone of the operation area, and has good stability, and the mandibular angle after removal is highly matched with the osteotomy guide plate. All the patients (10 cases in the first part and 5 cases in the second part) had the same postoperative effect as the preoperative design. There were no complications such as fracture, massive hemorrhage and infection during the operation. The bilateral mandible symmetry was well measured after the operation. Conclusion: the digital osteotomy guide plate can accurately copy the preoperative design data to the bone of the operation area. Under the guidance of the guide plate, the surgeon can accurately complete the osteotomy, which greatly improves the accuracy and symmetry of the operation. The transformation from experience to digitalization of mandibular angle osteotomy is realized, and the operation style of mandibular angle osteotomy is simplified. The standardized treatment mode is of great guiding significance to clinical work.
【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】：2014
【分類號】：R782
本文編號：2470086
[Abstract]:Objective: mandibular angle arc osteotomy is one of the common cosmetic operations in maxillofacial surgery. At present, the design of bilateral osteotomy line is mostly achieved by preoperative X-ray reading (CT) and computer software measurement design and surgical effect simulation. However, it has been a difficult problem how to accurately copy the preoperative surgical scheme and the measured data to the mandible of the patients during the operation. In addition, it is difficult for the operator to obtain an effective 3-D vision of the operation area, and then the design of the osteotomy line is less accurate based on the experience. In this study, the computer software 3D design, 3D printing and other digital technology will be used to accurately design the osteotomy line on the computer three-dimensional model before the operation. Through the computer software along the osteotomy line, a digital osteotomy guide plate which can match the three-dimensional shape of the mandible angle bone is designed and made. Then the data of the guide plate is printed out by the 3D printing technology, and the osteotomy is guided in the operation area. In order to improve the accuracy and symmetry of the operation, shorten the operation time, and reduce the incidence of complications methods: part one to determine the feasibility of inserting the guide plate into the operation area: first, convert the patient's CT data into the STL format file. And import a 3D printer (Z-printer350) to print a 3D model of the mandible. Then the CT data of the patients were transferred into the ProPlan software to reconstruct the three-dimensional model of the mandible in the computer, design the osteotomy line on the virtual three-dimensional model, and measure the mark points. According to the measured data, the osteotomy line was labeled on the printed 3D model of mandible, and the autocoagulation resin was kneaded along the labeled osteotomy line to make the osteotomy guide plate. After shaping, 2% iodine wine was soaked and sterilized and placed into the operation area. This study will determine the different shape of osteotomy guide plate corresponding to different mandibular angle and verify the feasibility of inserting different guide plate into the operation area. The second part designs the osteotomy line on the virtual three-dimensional model by the ProPlan software, then imports the osteotomy data into the GeoMagic software in the form of STL file, designs the digital osteotomy guide board, and finally prints the osteotomy guide board with the FDA-certified polylactic acid (PLA) material. The clinical application of intraoperative implantation was completed. Results: different osteotomy methods were designed for patients with different types of mandibular angle hypertrophy, and then different types of individualized osteotomy guide plates were determined. The shape of the guide plates was suitable for insertion into the operation area. The guide plate can fit closely with the bone of the operation area, and has good stability, and the mandibular angle after removal is highly matched with the osteotomy guide plate. All the patients (10 cases in the first part and 5 cases in the second part) had the same postoperative effect as the preoperative design. There were no complications such as fracture, massive hemorrhage and infection during the operation. The bilateral mandible symmetry was well measured after the operation. Conclusion: the digital osteotomy guide plate can accurately copy the preoperative design data to the bone of the operation area. Under the guidance of the guide plate, the surgeon can accurately complete the osteotomy, which greatly improves the accuracy and symmetry of the operation. The transformation from experience to digitalization of mandibular angle osteotomy is realized, and the operation style of mandibular angle osteotomy is simplified. The standardized treatment mode is of great guiding significance to clinical work.
【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】：2014
【分類號】：R782
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