本文選題：數(shù)字模擬 + 三維打印　； 參考：《南方醫(yī)科大學(xué)》2017年碩士論文

【摘要】：背景:人的面部外觀在個人的心目中占據(jù)著重要地位,對個人發(fā)展、人際交往等有著重要的影響。隨著時代的發(fā)展,顏面部整形逐漸為越來越多的人所熟悉和接受,其中,面部輪廓整形較為常見。在整形外科領(lǐng)域,面部輪廓整形是一個相當(dāng)復(fù)雜的過程,其通過改變面部局部組織含量的多少來調(diào)整面部外形;然而,難以確定其適當(dāng)?shù)淖兓俊Ｍ瑫r,它要求輪廓的改變符合外科醫(yī)生的設(shè)想和患者的期望。歷來,術(shù)者主要通過個人經(jīng)驗來評估可能產(chǎn)生的術(shù)后效果,缺乏客觀有效的工具來指導(dǎo)手術(shù)。這可能導(dǎo)致術(shù)后效果的不確定性。不符合求美者的術(shù)前期望。隨著影像學(xué)技術(shù)的發(fā)展,醫(yī)生從單純通過X光片等圖像獲取患者的相關(guān)信息,到應(yīng)用計算機分析處理二維圖像輔助術(shù)前設(shè)計,再到應(yīng)用三維重建技術(shù)聯(lián)合計算機模擬輔助術(shù)前術(shù)后的評估及手術(shù)規(guī)劃,應(yīng)用這些方式均可提供有效客觀依據(jù)輔助手術(shù)進(jìn)行,完善手術(shù)計劃,提高手術(shù)預(yù)后效果。然而,單一應(yīng)用三維數(shù)字模擬不能滿足患者復(fù)雜的手術(shù)需求,并且三維數(shù)字模擬局限于平面,缺乏立體直觀感。因此,這項研究是為了探討并評估在面部外形輪廓整形中聯(lián)合應(yīng)用數(shù)字模擬和三維快速成型技術(shù)指導(dǎo)手術(shù)進(jìn)行的準(zhǔn)確性和有效性,以獲得更好的預(yù)期結(jié)果,提高患者滿意度。患者和方法:招募對自身面部輪廓外形不滿意的患者,分為正面輪廓和側(cè)面輪廓整形。我們選擇鼻根地平、頦部短小、顴骨突出、下頜角肥大等患者進(jìn)行面部輪廓整形的研究。分為實驗組與對照組,實驗組為采用數(shù)字化模擬與快速成型技術(shù)聯(lián)合應(yīng)用輔助手術(shù),對照組為常規(guī)手術(shù)流程。具體實驗方法為:首先根據(jù)患者需求選擇應(yīng)用三維表面成像(側(cè)面輪廓)或計算機斷層成像(正面輪廓)重建個體三維數(shù)字化模型。然后對數(shù)字化三維模型進(jìn)行全面的研究,測量和分析,進(jìn)而做出術(shù)前診斷�；谌S重建,應(yīng)用數(shù)字模擬系統(tǒng)對骨和軟組織進(jìn)行切割,旋轉(zhuǎn)和平移操作等操作模擬手術(shù)的進(jìn)行,進(jìn)而得出模擬的術(shù)后結(jié)果。與患者溝通協(xié)商,確認(rèn)最佳的模擬效果。基于數(shù)字模擬效果,聯(lián)合應(yīng)用三維快速成型技術(shù)定制個性化的手術(shù)模板用以熟悉并指導(dǎo)手術(shù)的操作。術(shù)后,通過頭顱測量分析、醫(yī)生的相似性評價、患者的滿意度評分來主客觀評價數(shù)字模擬的準(zhǔn)確性與有效性。結(jié)果:根據(jù)專業(yè)外科醫(yī)生的評級,三維表面成像和CT三維成像兩套三維成像模擬系統(tǒng)的數(shù)字模擬的平均總精度分別為87.5%,83.4%。滿意度方面,實驗組中患者的平均滿意度均在3.4以上,相對于對照組,存在統(tǒng)計學(xué)差異。頭顱測量分析顯示,術(shù)前模擬與實際術(shù)后結(jié)果之間的平均差異限于2.17 mm,兩個數(shù)字模擬系統(tǒng)的模擬改變量與實際改變之間的差異小,兩者較為一致,均未見明顯統(tǒng)計學(xué)差異。兩個數(shù)字化模擬系統(tǒng)術(shù)前模擬與術(shù)后差異之間的比較亦未見明顯差異。結(jié)論:數(shù)字模擬是一個精確有效的方法,用于面部輪廓整形中,可以獲得有效和可靠的術(shù)前預(yù)測結(jié)果。聯(lián)合應(yīng)用兩種模擬系統(tǒng),有效針對面部外部軟組織輪廓和內(nèi)部骨組織,可良好應(yīng)對面部輪廓整形的復(fù)雜需求。輔助三維打印個性化定制手術(shù)模板能模擬手術(shù)操作,直觀指導(dǎo)手術(shù)的進(jìn)行,獲得更好的預(yù)期結(jié)果。同時,與患者溝通確定手術(shù)方案,建立良好的醫(yī)患教育,提高患者術(shù)后滿意度。
[Abstract]:Background: human facial appearance occupies an important position in the mind of individuals, and has an important influence on personal development and interpersonal communication. With the development of the times, facial shaping is gradually familiar and accepted by more and more people. Among them, facial contour shaping is more common. In the field of plastic surgery, facial contour shaping is a equivalent. A complex process that adjusts the facial contour by changing the amount of local tissue in the face; however, it is difficult to determine the appropriate amount of change. At the same time, it requires that the changes of the contour conform to the surgeon's imagination and the expectation of the patient. Tools are used to guide the operation. This may lead to uncertainty in postoperative effects. It does not conform to the expectations of the beauty beg. With the development of imaging techniques, doctors obtain information from the patients only through images such as X ray, to the application of computer analysis to process two-dimensional image auxiliary design, and then to the application of three-dimensional reconstruction techniques. The application of these methods can provide effective and objective basis for the operation, improve the operation plan, and improve the outcome of the operation. However, the single application of 3D digital simulation can not meet the patient's complicated operation needs, and the three-dimensional digital simulation is limited to the plane and lacks the stereoscopic vision. Therefore, this study is designed to explore and evaluate the accuracy and effectiveness of the combined application of digital simulation and three-dimensional rapid prototyping in facial contour shaping in order to obtain better expected results and improve patient satisfaction. Patients and methods: recruit patients with discontentions of their facial contour to be divided into The frontal and lateral contour shaping. We chose the nasal root flat, the chin short, the zygomatic protrusion, the mandibular angle hypertrophy and other patients for facial contour shaping. The experimental group and the control group were divided into the experimental group and the control group. The control group was the routine procedure. The specific experimental method was used in the control group. Firstly, the three-dimensional digital model of the individual is reconstructed by using the three-dimensional surface imaging (side contour) or computed tomography (frontal contour). Then the digital 3D model is studied, measured and analyzed, and then the preoperative diagnosis is made. Based on the three-dimensional reconstruction, the digital simulation system is applied to the bone and soft tissue. Perform a simulated operation, such as cutting, rotation, and translation, and then getting the simulated results. Communicate with the patient to confirm the best simulation results. Based on the numerical simulation effect, the combined application of the three-dimensional rapid prototyping technology to customize the personalized surgical templates is used to familiarize and guide the operation. Quantitative analysis, doctor's similarity evaluation, patient satisfaction score for the accuracy and effectiveness of the subjective and objective evaluation digital simulation. Results: the average total accuracy of the digital simulation of two three-dimensional imaging simulation systems based on the professional surgeon's rating, the three dimensional surface imaging and the CT three-dimensional imaging system is 87.5%, the 83.4%. satisfaction aspect, the experimental group The average degree of satisfaction of the patients was above 3.4, compared with the control group, there was a statistical difference. The average difference between the pre operation simulation and the actual postoperative results was limited to 2.17 mm, and the difference between the analog changes of the two digital simulation systems and the actual changes was small. There is no significant difference between the preoperative simulation and the postoperative differences between the two digital simulation systems. Conclusion: digital simulation is an accurate and effective method for facial contour shaping, which can obtain effective and reliable preoperative prediction results. The combined application of two analog systems is effective against the external soft tissue profile and internal face of the face. Bone tissue can well respond to the complex needs of facial contour shaping. Assisted three-dimensional printing of personalized customized surgical templates can simulate surgical operations, direct the operation and obtain better expected results. At the same time, communicate with the patients to determine the operation plan, establish a good medical education, and improve the patient's postoperative satisfaction.

【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R622

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