导航及内镜技术联合正颌手术矫治髁突骨软骨瘤伴颌骨畸形数字化流程的建立与应用  

Establishment and application of a digital workflow in the treatment of condylar osteochondroma and secondary dentofacial deformities using image-guided endoscopic navigation combined with orthognathic surgery

作　　者：沈末伦[1] 余婧爽 于洪波[1] 孙昊[1] 沈国芳[1] 王旭东[1] Shen Molun Yu Jingshuang Yu Hongbo Sun Hao Shen Guofang Wang Xudong(Department of Oral and Craniomaxillofacial Surgery, Ninth People＇s Hospital, Shanghai Jiao Tong University School of Medicine ＆ Shanghai Key Laboratory of Stomatology, Shanghai 200011, China （Shen ML, Yu JS, Yu HB, Sun H, Shen GF, Wang XD)

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

出　　处：《中华口腔医学杂志》2016年第12期728-733,共6页Chinese Journal of Stomatology

基　　金：上海市高峰学科建设计划（2015）;上海市市级医院新兴前沿技术联合攻关项目（SHDC12013103）

摘　　要：目的 建立导航及内镜联合正颌手术矫治髁突骨软骨瘤伴颌骨畸形的数字化流程,评价其临床应用效果,为临床提供参考.方法 回顾分析2012年1月至2015年6月于上海交通大学医学院附属第九人民医院口腔颅颌面科就诊的36例单侧髁突骨软骨瘤患者的资料,所有患者均采用数字化三维手术设计与模拟技术于术前确定手术方案,术中在导航及内镜辅助下精确切除患侧髁突,同期行正颌手术矫正伴发的颌骨畸形.术后行CT检查,采用ProPlan CMF 2.0软件将术后CT三维模型与术前虚拟截骨模型进行匹配,分别在虚拟截骨平面和实际截骨平面上取对应4个点（乙状切迹和下颌支后缘与髁突截骨平面的交点分别定为最前点和最后点,两点连线中点的垂线与截骨平面内外侧边缘的交点分别定为最内点和最外点）;测量虚拟截骨平面与实际截骨平面上对应点间的直线距离,分析髁突切除术截骨误差.结果 36例患者均获得满意的临床疗效,术后CT显示髁突骨软骨瘤均被完全切除,术前设计与实际手术的截骨量基本一致,其中最前点的截骨误差最小,为（0.24±0.17） mm,而最后点的截骨误差最大,为（3.86±1.03） mm.术后随访6～ 12个月,肿瘤无复发.结论 导航及内镜技术联合正颌手术矫治髁突骨软骨瘤伴颌骨畸形的数字化治疗流程临床疗效满意,值得推广.Objective To establish a digital workflow in the treatment of mandibular condylar osteochondroma with secondary dentofacial deformities using navigation and endoscope combined with orthognathic surgery.Methods Thirty-six patients with unilateral condylar osteochondroma were analyzed retrospectively.Preoperative planning and simulation were carried out on the digital three-dimansional （3D）model in all patients.With the aid of image-guided endoscopic navigation,osteochondroma resection and condylectomy were accurately performed.Secondary dentofacial deformities were simultaneously corrected using orthognathic surgery.All patients were followed up regularly and received postoperative CT scans.The preoperative simulated model and the postoperative actual model were matched using ProPlan CMF 2.0 software.Four corresponding points were marked in the virtual and actual ostectomy plane,respectively.The intersections of mandibular sigmoid notch and posterior ramusrim with condylectomy plane were marked as the anterior point and the posterior point,respectively.The perpendicular bisector of the line from the anterior point to the posterior point was intersected with the lateral and medial margin of condylectomy plane to form the lateral point and the medial point,respectively.The straight-line distances between the corresponding points in the virtual and actual ostectomy plane were respectively measured to analyze the ostectomy discrepancy.Results All of 36 patients obtained satisfactory clinical effects.Facial symmetry and morphology were greatly improved.Postoperative CT showed that condylar tumors were completely removed.The preoperative simulated model and the postoperative actual model were matched.The average discrepancy between the planned and actual surgical resection was minimal on the anterior points （[0.24±0.17] mm） andthe mean error was maximal on the posterior points （[3.86±1.03] mm）.The patients showed no signs of tumor recurrence in the 6 to 12 months of follow-up.Conclusions Endoscope-assisted

关 键 词：正颌外科手术 骨软骨瘤 下颌骨髁状突 内镜 

分 类 号：R739.8[医药卫生—肿瘤]