中面部牵引成骨疗效的计算机辅助评估  

Computer Assistant Evaluation of the Therapeutic Effects of Midface Distraction Osteogenesis

作　　者：徐海淞[1] 王衡健[1] 俞哲元[1] 袁捷[1] 曹德君[1] 柴岗[1] 韦敏[1] 穆雄铮[2] 

机构地区：[1]上海市上海交通大学医学院附属第九人民医院,200011 [2]上海市复旦大学上海医学院附属华山医院,200031

出　　处：《组织工程与重建外科杂志》2014年第1期26-29,共4页Journal of Tissue Engineering and Reconstructive Surgery

摘　　要：目的应用计算机辅助的三维影像重建及测量技术,评估牵引成骨矫治中面部发育不良畸形的手术疗效。方法自2005年至2010年,对11例严重中面部发育不良患者,采用Le FortⅢ型颅面部截骨和牵引成骨术进行治疗,术前、术后运用计算机辅助的三维影像测量技术,行上气道CT三维重建,分析气道变化;头颅CT三维重建,分析突眼度、上下颌关系改变,及中面部在前颅底平面牵引前移的量,进而评估牵引成骨术在矫治中面部严重发育不良中的临床价值。结果 11例患者经Le FortⅢ型颅面部截骨和牵引成骨术治疗后,气道梗阻情况得到解除,面部外形明显改善。术后上气道平均体积增加(9.13±6.94)cm3,气道梗阻较术前明显改善(P<0.01);术前平均突眼度(21.23±3.3)mm,术后(11.4±3.5)mm,症状改善明显(P<0.01);术后ANB矫正到平均(7.16±3.41)°,SNA矫正至平均(83.06±5.85)°,咬牙合关系改善(P<0.01);术后中面部在前颅底平面平均前移(20.27±8.04)mm,术后平均随访5.4个月,CT示前移部分新生骨组织形成。结论 Le FortⅢ型截骨、牵引成骨手术治疗儿童中面部严重发育不良,可有效解除气道梗阻情况,改善面部外形。三维影像重建及测量技术是一种理想的评估方法。Objective To evaluate the therapeutic effects of midface distraction osteogenesis in the treatment of midface hypoplasia by 3D reconstruction and measurement. Methods From 2005 to 2010, 11 cases with severe midface hypoplasia were treated with Le Fort Ⅲ osteotomy and distraction osteogenesis. The change of upper airway, eyeball position, occlusion and midface position were all measured by 3D reconstruction and measurement pre- and postoperatively. Results After Le Fort Ⅲ osteotomy and distraction osteogenesis, airway obstruction was effectively relieved and facial appearance was im-proved significantly. The upper airway volume was increased to （9.13±6.94） cm3 on average, and airway obstruction was effec-tively relieved comparing with preoperative values （P〈0.01）. The degree of exophthalmos was about （21.23±3.3） mm before operation, and （11.4±3.5） mm after operation. The proptosis was improved significantly （P〈0.01）. The ANB was （7.16±3.41） °; after operation, and SNA was （83.06 ±5.85） °; after operation. The occlusion was corrected. The midface was ante-displaced about （20.27±8.04） mm on average, and the new bone formation was observed by CT scanning after 5.4 months ’ follow-up. Conclusion Le Fort Ⅲ osteotomy and distraction osteogenesis in treating midface hypoplasia can improve the function of upper airway and the appearance of midface. 3D reconstructive and measurement is an ideal evaluation method.

关 键 词：牵引成骨 中面部发育不良 三维重建 计算机辅助测量 

分 类 号：R319[医药卫生—基础医学]