虚拟设计与传统模型外科矫治偏突颌畸形的对比研究  

Comparison between computer aided simulation and dental model orthognathic surgery for the treatment of patients with mandibular excess and facial asymmetries

作　　者：沈舜尧[1] 陈天天[2] 卢陈佩 姜腾飞[1] 王旭东[1] 沈国芳[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院口腔颅颌面科上海市口腔医学重点实验室,200011 [2]上海市徐汇区牙病防治所口腔修复科,200030

出　　处：《中华口腔医学杂志》2016年第11期651-655,共5页Chinese Journal of Stomatology

基　　金：上海市市级医院新兴前沿技术联合攻关项目（SHDC12013103）

摘　　要：目的 比较传统模型外科和虚拟正颌外科治疗的偏突颌畸形患者术后面部不对称性的改善情况,以期为临床提供参考.方法 回顾2013年1月至2014年7月上海交通大学医学院附属第九人民医院收治的偏突颌畸形患者,获取传统石膏模型外科和虚拟设计正颌外科治疗患者（分别为模型外科组和虚拟设计组,每组各30例）CT数据,以鼻根点为原点,水平面为过双侧耳点及左侧眶下点构成的平面,正中矢状面为过颅底点、鼻根点且垂直于水平面的平面,冠状面为过鼻根点并同时垂直于水平面和正中矢状面的平面,建立三维测量参考坐标系.以上切牙点、上颌双侧第一磨牙近中颊点构成的三角形,下切牙点、下颌双侧第一磨牙近中颊点构成的三角形和颏下点、下颌双侧体部点构成的三角形分别代表上颌（骀）平面、下颌（骀）平面及下颌体部平面,对两组患者正颌手术前后各平面的偏航角和侧滚角进行成组t检验,比较两组偏突颌畸形不对称性的矫正效果.结果 经检验数据符合正态分布,其中下颌（骀）平面的偏航角（模型外科组为0.36°±0.48°,虚拟设计组为0.84°±0.36°,P=0.043）和侧滚角（模型外科组为0.26°±0.77°,虚拟设计组为0.54°±0.40°,P=0.032）、下颌骨体部平面的偏航角（模型外科组为0.60°±1.04°,虚拟设计组为0.23°±0.52°,P=0.008）和侧滚角（模型外科组为0.82°±0.72°,虚拟设计组为0.53°±0.37°,P=0.028）,两组差异均有统计学意义;而上颌（骀）平面的偏航角和侧滚角两组差异均无统计学意义（P〉0.05）.结论 相比石膏模型外科,虚拟正颌外科对下颌骨轮廓对称性的纠正有较明显的优势.Objective To evaluate the results of the orthognathic surgery with computer aided simulation-three-dimensional（3D） printed surgical guide and dental model surgery in the treatmemt of patients with mandibular excess and facial asymmetries.Methods The coordinate system was built in ProPlan CMF 2.0 software,and the horizontal plane consisted of PoL,PoR,OrL,middle sagittal plane through nasion point and basion point and the plane perpendicular to the horizontal plane,coronoid plane through nasion point and the plane perpendicular to the horizontal plane and middle sagittal plane.The orientation of maxilla and mandibular distal segment was calculated by each triangle（U 1-U6L-U6R,L1-L6L-L6R,Me-M5L-M5R） before and after orthognathic surgery.A total of 60 mandibular excess patients with facial asymmetries were enrolled in this retrospective study.They were divided into two groups,group I with computer aided simulation,group Ⅱ with dental model surgery.The difference of maxillary occlusal plane roll and yaw angle,mandibular occlusal plane roll and yaw angle,and mandibular body plane roll and yaw angle were calculated.Statistical analysis was performed with SPSS 17.0 software.Results The yaw angle of mandibular occlusal plane of the dental model surgery and computer aided simulation was 0.36°± 0.48° and 0.84° ±0.36° （P=0.043）,respectively.The roll angle of mandibular occlusal plane of the dental model surgery and computer aided simulation was 0.26°±0.79° and 0.54°±0.40°（P=0.032）,respectively.The yaw angle of mandibular body plane of the dental model surgery and computer aided simulation was 0.60°± 1.04° and 0.23°±0.52°（P=0.008）,respectively.The roll angle of mandibular body plane of the dental model surgery and computer aided simulation was 0.82°± 0.72° and 0.53°± 0.37° （P=0.028）,respectively.The changes in computer aided simulation group were more obvious than that in the dental model surgery group,but the difference was not significant in the yaw angle of maxillary occlus

关 键 词：计算机辅助设计 正颌外科手术 三维打印 模型外科 

分 类 号：R782[医药卫生—口腔医学]