三维头模设计及个体化模板引导技术在OSAHS患者下颌骨牵引成骨术中的应用  

Application of 3D head mold planning and individualized templates in mandibular distraction

作　　者：李阳[1] 伊彪[1] 王兴[1] 李自力[1] 梁成[1] 王晓霞[1] 刘筱菁[1] 何伟[1] 

机构地区：[1]北京大学口腔医学院·口腔医院颌面外科,100081

出　　处：《中华口腔正畸学杂志》2014年第2期95-99,共5页Chinese Journal of Orthodontics

基　　金：首都临床特色应用研究,项目编号：Z13110700220000,课题编号：Z131107002213092

摘　　要：目的 探索术前三维头模设计及个体化模板引导在下颌骨牵引成骨术中的应用,并且评估手术的治疗效果.方法 选择原发或继发小颌畸形患者10例,均伴有中度或者重度的阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea-hypopnea syndrome,OSAHS）.根据三维螺旋CT的数据制作三维头模,在三维头模上模拟手术截骨以及牵引器的安放,制作个体化模板.术中应用个体化模板指导截骨线的位置以及牵引器的安放.术后5～7 d的间歇期后,开始以每天1 mm的速度行骨牵引至牵引结束.术后3～6个月二次手术去除牵引器.结果 10例患者顺利完成下颌骨牵引成骨治疗,第一次手术平均手术时间为（1.6±1.3）h.10例患者的20侧下颌骨平均牵引长度为（23.6±7.5） mm.术前睡眠呼吸暂停低通气指数（apnea and hypopnea index,AHI）为（37.1±13.7）次/h,睡眠时最低血氧饱和度（lowest oxygen desaturation,LSAT）为75.2％±18.4％;术后AHI为（2.7±4.8）次/h,LSAT为92.1％±5.3％.所有患者的牵引成骨区成骨良好,均未出现成骨不良、下牙槽神经损伤及牵引故障等严重并发症.结论 术前三维头模设计可以很好的模拟牵引成骨术中的截骨位置及牵引器的安放,避免损伤重要解剖结构;应用个体化模板引导可以提高下颌骨牵引成骨术截骨及牵引器安放的精确性,缩短手术时间,降低手术难度及风险.Objective To investigate the applications of preoperative 3D head modeling and individualized template guiding in mandibular distraction and to evaluate the effect postsurgery.Methods 10 patients with mandibular micrognathia,who developed moderate to severe OSAHS were selected.All patients underwent mandibular distraction.3D head models were printed based on spiral CT data.Preoperative simulations of osteotomy and distractor placement were done with the 3D head models,and accordingly,individualized templates were fabricated.During surgery,the templates guided the position of osteotomy line and placement of distractors.The distraction begun 5 ～ 7 days after operation at a frequency of 1 mm/day.After distraction,the distractors were maintained for 3～6 months till removed.Results All 10 cases were treated successfully.Average operation time was （1.6 ± 1.3） h.The mean distraction distance was （23.6 ± 7.5） mm.The preoperative polysomnography showed an apnea-hypopnea index of （37.1 ± 13.7） per hour and a lowest oxygen saturation of （75.2 ± 18.4）％.Postoperative polysomnography showed improvement that apnea-hypopnea index changed to （2.7 ± 4.8） per hour and lowest oxygen saturation to （92.1 ± 5.3）％.No complication occurred during treatment.Conclusions The preoperative simulations show excellent guides during surgery,which will improve surgical precision,shorten the operation time,avoid injury of important anatomical structures,reduce operation difficulties and minimize possible risks.

关 键 词：小颌畸形 阻塞性睡眠呼吸暂停低通气综合征 三维打印 

分 类 号：R782.2[医药卫生—口腔医学]