【摘要】：目的：運(yùn)用數(shù)字化技術(shù)針對(duì)顱面不對(duì)稱(chēng)患者優(yōu)化耳廓再造的定位及特型耳支架設(shè)計(jì),尋求一種可以提高術(shù)后對(duì)稱(chēng)效果的方法。對(duì)象及方法：1.對(duì)象在2014年9月-2015年3月入院進(jìn)入我組治療的合并顱頜面畸形的單側(cè)小耳畸形患者中,符合入選條件的50例患者：男36例,女14例,年齡5歲-20歲,平均年齡8.28歲。分為研究組、對(duì)照組兩組,每組25人。2.方法(1)應(yīng)用三維攝影掃描技術(shù)對(duì)研究組患者行耳廓、顱面掃描,并以掃描數(shù)據(jù)建立耳廓、顱面部數(shù)字化模型,以數(shù)字化技術(shù)在該數(shù)字化模型上進(jìn)行再造耳廓定位并獲取耳支架形態(tài)參數(shù)及矯正參數(shù)。(2)應(yīng)用螺旋CT掃描,對(duì)研究組患者行肋軟骨掃描,并通過(guò)CT三維重建技術(shù)獲得肋軟骨數(shù)字化模型,并在數(shù)字化模型上測(cè)量肋軟骨形態(tài)學(xué)參數(shù)估計(jì)肋軟骨組織量。(3)根據(jù)上述耳廓定位信息、參數(shù)及肋軟骨組織量,研究組行個(gè)性化耳支架的制備并行擴(kuò)張法耳廓再造術(shù),對(duì)照組常規(guī)手術(shù)。(4)對(duì)研究組及對(duì)照組術(shù)后一月進(jìn)行隨訪,由術(shù)者、第三方整形醫(yī)師、家屬,第三方家屬針對(duì)再造耳正面觀、側(cè)面觀、后面觀等視角對(duì)稱(chēng)性進(jìn)行獨(dú)立評(píng)分(其中第三方整形醫(yī)師及第三方家屬為盲評(píng)),以?xún)?yōu)、良、差表示,針對(duì)對(duì)稱(chēng)性?xún)?yōu)良率進(jìn)行K(Kappa)檢驗(yàn),進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果：1.三維攝影掃描建立的頭顱及耳廓數(shù)字化模型形態(tài)清晰,逼真立體感強(qiáng)；2.數(shù)字化三維模型中健側(cè)耳廓、顱面與患側(cè)耳廓顱面完成鏡像操作及交互對(duì)比定位后,健耳鏡像與患側(cè)顱面間存在間隙；3.數(shù)字化三維模型中通過(guò)軟件操作獲得雙側(cè)耳廓良好對(duì)稱(chēng)性后,可通過(guò)軟件對(duì)定位信息進(jìn)行標(biāo)定。在數(shù)字化模型中測(cè)量出耳廓形態(tài)學(xué)參數(shù)及矯正參數(shù),準(zhǔn)確反映雙耳基底面差異。4.術(shù)后一月隨訪結(jié)果示：術(shù)者、第三方整形醫(yī)師、家屬、第三方家屬對(duì)研究組評(píng)分高于對(duì)照組,其中第三方整形醫(yī)師、家屬、第三方家屬評(píng)分結(jié)果有顯著性差異。結(jié)論：1.通過(guò)三維攝影掃描技術(shù)可以建立良好的耳廓、顱面數(shù)字化模型指導(dǎo)臨床操作。2.通過(guò)對(duì)數(shù)字化模型進(jìn)行分析可以獲得再造耳廓定位信息,再造耳耳支架設(shè)計(jì)所需形態(tài)學(xué)參數(shù)及矯正參數(shù)。3.以上述定位信息及參數(shù)信息為指導(dǎo)對(duì)顱頜面不對(duì)稱(chēng)患者進(jìn)行耳廓再造術(shù),術(shù)后隨訪耳廓對(duì)稱(chēng)性效果較常規(guī)方法所得對(duì)稱(chēng)性效果好。
[Abstract]:Objective: to optimize the location of auricle reconstruction and the design of special ear stent for patients with craniofacial asymmetry by digital technique, and to find a method to improve the effect of postoperative symmetry. Object and method: 1. Participants were admitted to our group from September 2014 to March 2015 for unilateral microauricular malformation with craniomaxillofacial malformation. The 50 patients who met the criteria were 36 males and 14 females, aged from 5 to 20 years, with an average age of 8.28 years. Divided into study group, control group two groups, each group of 25 people. 2. Methods (1) the auricle and craniofacial images of the patients in the study group were scanned by three-dimensional radiography, and the digital models of auricle and craniofacial were established by scanning data. Digital technique was used to locate the reconstructed auricle and obtain the shape and correction parameters of the scaffold. (2) the patients in the study group were scanned by spiral CT scanning, and the patients in the study group were scanned with costal cartilage. The digital model of costal cartilage was obtained by CT 3D reconstruction technique, and the morphological parameters of costal cartilage were measured to estimate the amount of costal cartilage tissue. (3) according to the above auricle location information, the parameters and the amount of costal cartilage tissue were measured. The patients in the study group underwent auricle reconstruction with individualized auricular stent and dilated auricle reconstruction. (4) the patients in the study group and the control group were followed up for one month after operation, followed up by the operator, the third party plastic surgeon, the family members, the third party plastic surgeon, and the control group. The third party family evaluated the symmetry of the positive view, the side view and the back view of the reconstructed ear independently (including the third party plastic surgeon and the third party family member as the blind evaluation), expressed as excellent, good and bad, and carried out the K (Kappa) test on the symmetry excellent and good rate. Statistical analysis was carried out. The result is 1: 1. The digital model of skull and auricle established by three-dimensional photography is clear in shape and realistic in three-dimensional sense. 2. In the digitized 3D model, there is a gap between the healthy ear image and the affected craniofacial image after the mirror image operation and the interactive comparative positioning between the craniofacial and the cranial surface of the affected side. 3. The localization information can be calibrated by software after the good symmetry of the bilateral auricles is obtained by software operation in the digital 3D model. The morphological parameters and correction parameters of auricle were measured in the digital model. The results of follow-up for one month after operation showed that the score of the study group was higher than that of the control group, and the scores of the third party plastic surgeon, the family member and the third party family member were higher than those of the control group. Conclusion 1. A good auricle and craniofacial digital model can be established by three-dimensional photography to guide clinical operation. 2. Through the analysis of digital model, the location information of reconstructed auricle can be obtained, and the morphological parameters and correction parameters needed for the design of auricle scaffold can be obtained. Under the guidance of the above location information and parameter information, the effect of auricle reconstruction in patients with craniomaxillofacial asymmetry was better than that obtained by conventional methods.
【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】：2015
【分類(lèi)號(hào)】：R622;TP391.7

【參考文獻(xiàn)】

相關(guān)期刊論文 前9條

1 陳志明;劉鋒;;16層螺旋CT多種重建方法在診斷肋軟骨骨折中的應(yīng)用[J];中國(guó)CT和MRI雜志;2013年05期

2 任露;張亞林;;HRCT及三維重建技術(shù)對(duì)視神經(jīng)管骨折的診斷價(jià)值[J];中國(guó)CT和MRI雜志;2015年02期

3 許美邦;滕利;;治療下頜骨發(fā)育不良的新方法—曲線牽張成骨[J];中國(guó)美容醫(yī)學(xué);2011年02期

4 汪希;楊群;張余光;錢(qián)云良;陳駿;;第一二鰓弓綜合征的綜合手術(shù)治療[J];中國(guó)美容整形外科雜志;2006年04期

5 吳國(guó)鋒,趙銥民,渠樂(lè),曹健,劉璐;應(yīng)用層去圖像法和反求工程完成單側(cè)耳缺損修復(fù)的三維反求設(shè)計(jì)[J];中國(guó)臨床康復(fù);2004年14期

6 何樂(lè)人;張晉光;蔣海越;楊慶華;莊洪興;;合并顱面畸形的小耳畸形耳廓再造術(shù)[J];中國(guó)修復(fù)重建外科雜志;2012年12期

7 吳榮薇;潘博;;小耳畸形的流行病學(xué)和遺傳學(xué)研究進(jìn)展[J];中華臨床醫(yī)師雜志(電子版);2013年01期

8 陳克光;傅窈窈;楊琳;戴培東;張?zhí)煊?;三維耳郭導(dǎo)板的制作及其在耳郭再造術(shù)中的應(yīng)用[J];組織工程與重建外科雜志;2014年01期

9 燕靜杰;楊慶華;宋宇鵬;劉戈;馬辰浩;;三維激光掃描技術(shù)應(yīng)用于再造耳廓遠(yuǎn)期變化的研究[J];中華耳科學(xué)雜志;2013年04期

相關(guān)碩士學(xué)位論文 前1條

1 燕靜杰;三維激光掃描技術(shù)應(yīng)用于再造耳廓遠(yuǎn)期變化的研究[D];北京協(xié)和醫(yī)學(xué)院;2014年

，

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