三维技术联合术后血流监测辅助完成全鼻再造  

Total nasal reconstruction based on three-dimensional technology combined with hemodynamics monitoring after operation

作　　者：郑万玲 王苹苹 温敏敏 陶胜军 魏韩笑 张爱君 金培生 Zheng Wanling;Wang Pingping;Wen Minmin;Tao Shengjun;Wei Hanxiao;Zhang Aijun;Jin Peisheng(Department of Plastic Surgery,Xuzhou Medical College Affiliated Hospital,Xuzhou 221002,China)

机构地区：[1]徐州医科大学附属医院整形外科,221002

出　　处：《中华整形外科杂志》2018年第11期912-918,共7页Chinese Journal of Plastic Surgery

基　　金：江苏省科技厅科技计划项目(BE2016644).

摘　　要：目的 探讨三维扫描、三维打印技术联合术后血流监测辅助完成全鼻再造手术的方法 和临床效果.方法 ①三维扫描技术:应用Artec Eva 3D扫描仪记录2016年9月至2017年2月徐州医科大学及其附属医院的500名志愿者的鼻部数据,其中男138名,女362名,建立正常人鼻部数据库.对拟行额部皮瓣全鼻再造术的患者进行面部三维扫描.②三维打印技术:参照患者的残余鼻数据,结合正常人鼻部数据库、手术医师及患者意见,设计出符合患者的个性化鼻外形,三维打印出鼻部实体模型,为全鼻再造手术提供指导.③术后监测:应用激光多普勒血流仪及Geomagic Qualify软件对术后额部皮瓣的血供及回缩率进行测量,记录术后皮瓣的血流值、温度及表面积变化,并进行分析.结果 成功建立了淮海地区正常人群的鼻部数据库,总体上鼻宽为面宽的1/4,鼻长为发际线到下颏距离的1/3.于2017年2月至2018年6月采用上述流程共完成7例全鼻再造手术,均成功打印出拟重建的鼻模型,并用其指导术中切取皮瓣,平均手术时间为(2.45±0.75)h.术后血流监测显示皮瓣血供良好.术后随访5~15个月,平均12.5个月,术后1个月皮瓣回缩率为(21.8±2.72)%,6个月为(29.1±1.82)%,患者对鼻外形满意.结论 基于三维扫描和三维打印技术的额部皮瓣全鼻再造术,通过无创的方式提供客观的指标,辅助鼻部精细结构的重塑,术后对皮瓣血运情况的监测促进了全鼻再造手术的顺利完成.Objective The purpose is to explore the method and clinical effects of total nasal reconstruction with the assistance of three-dimensional (3D) scanning, 3D printing and monitoring the blood circulation after operation.Methods 3D scanning: Artex Eva 3D scanner was used to record the nose data of 500 volunteers from Xuzhou Medical University and its affiliated hospital from September 2016 to February 2017. A nose database of normal individuals was established, of which male was 138 and female was 362. In addition, 3D facial scanning was performed in patients wish to total nasal reconstruction. 3D printing: The individualized nasal structure was designed, with the assistant of patients′facial characteristics, combined with the normal nose database and the opinion of the patients. Anactual nose model was used as guidance during the operation. Postoperative monitoring: The blood flow and the retraction rate of forehead flap after surgery were measured using Laser Doppler Flowmeter and Geomagic Qualify software. The blood flow values, the temperature and the surface area of the flap were recorded and analyzed.Results The nasal database of normal people in the Huaihai region successfully established. Overall, the width of the nose takes up a quarter of the width of the faces, and the length is 1/3 of the distance from the hairline to the chin. From February 2017 to June 2018, 7 cases underwent total nasal reconstruction operations were performed by this procedure. The nasal models were all successfully printed out, as the guide of flap taken during the operation. The mean operation time of the cases was (2.45±0.75) h, and the follow-up time was 5-15 months, with an average of 12.5 months. After the operations, the retraction rate of the forehead flap were (21.8±2.72)% in one month, and (29.1±1.82)% in six months. All patients are satisfied with the nasal appearance.Conclusions Nasal reconstruction with forehead flap based on 3D scanning and 3D printing, provides objective targets for nasal fine-structure in a noni

关 键 词：全鼻再造术 三维扫描 三维打印 外科皮瓣 血流监测 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]