正畸图像管理软件辅助设计正颌手术精确性的研究  

The accuracy of orthodontic imaging management software in virtual simulating orthognathic surgery

作　　者：李海振 乔虎[2] 任战平[3] 曹甜[2] 陶永炜[3] 周洪[2] 侯玉霞[1] Li Haizhen;Qiao Hu;Ren Zhanping;Cao Tian;Tao Yongwei;Zhou Hong;Hou Yuxia(Clinical Research Center of Shaanxi Province for Dental and Maxillofacial Diseases,College of Stomatology,Xi＇an Jiaotong University 710004;Departmentof Orthodontics,College of Stomatology,Xi＇an Jiaotong University 71000;Department of Cranio-Maxillofacial Trauma Plastic Surger)

机构地区：[1]西安交通大学口腔医院正畸科陕西省牙颌疾病临床医学研究中心,710004 [2]西安交通大学口腔医院正畸科,710004 [3]西安交通大学口腔医院正畸科颅颌面整形创伤外科,710004

出　　处：《中华口腔正畸学杂志》2018年第3期144-148,共5页Chinese Journal of Orthodontics

基　　金：陕西省重点研发计划（2018SF-025）;西安交通大学口腔医院陕西省牙颌疾病临床医学研究中心开放课题（2017YHJB04）

摘　　要：目的介绍正畸图像管理软件模拟正颌外科的流程并证明其临床使用精确性,为正畸-正颌联合治疗提供精准且简便的数字化解决方法.方法 选择正颌手术患者12例,术前采集锥体束CT（cone beam computer tomography,CBCT）、扫描牙列数据、三维面相,使用Dolphin软件设计正畸-正颌手术方案.通过构建三维模型、三维建系、定义截骨线、定义标志点、三维分析和设计、3D打印等环节,制作手术（牙合）板,将3D打印（牙合）板应用于正颌手术中.术后1周再次拍摄CBCT,选取颅底作为基准,将术前CBCT和术后CBCT三维重叠,计算主要标志点的术前术后的实际移动量,使用配对样本t检验验证主要标志点术前模拟值和术后实际移动量之间的一致性.结果 正畸图像管理软件可以三维辅助设计正颌外科（牙合）板,3D打印（牙合）板加工精度高,术中戴用稳定性良好,对颌骨和咬合关系的定位准确;CBCT三维重叠后各个标志点（ANS、A、U1、PNS、L1、B、Pog、Me）的术前模拟移动量和术后实际移动量未见统计学差异（P＞0.072）,标志点（ANS、A、U1、PNS、L1、B）术前模拟移动量和术后实际移动量差值在0.57～1.53 mm之间.结论 正畸图像管理软件可以整合软组织、颌骨、牙齿的三维数据,生成的正颌手术（牙合）板加工精度高,对颌骨位置和咬合关系定位准确,Dolphin软件是一套简便、精准的数字化正颌手术虚拟辅助设计系统.Objective To evaluate the accuracy of surgical simulation in orthognathic surgery and find a reliable method for surgical simulation.Methods 12 patients undergoing combined orthodontic-orthognathic surgical treatment were selected.The CBCT data,scanned dental data and 3D facial photo were collected before surgery.The orthodontic-orthognathic surgery was simulated using orthodontic imaging management software （constructing 3D model,setting up coordinate system,defining osteotomy line,defining landmarks,3D analysis and designing,3D printing and et al.） The digital occlusal splint was completed and applied to orthognathic surgery.The skull base area was selected as the reference for superimposition of CBCT to verify the changes of the main landmarks in three dimensions.The preoperative and postoperative error of the main landmarks was calculated.Paired samples t test was used to verify the consistency between the simulation aided by the software and the result of actual surgery.Results The 3D printed Occlusal splint designed using the software was stable and accurate for occlusion and jaw location.The main landmarks （ANS,A,U1,PNS,L1,B,Pog,Me） showed no statistical difference between the preoperative predicted movements and actual operative movements after three dimensional superimposition （P〉 0.072）.The errors on three dimensions were between 0.57 mm-1.53 mm.Conclusions Surgical simulation in orthognathic surgery designed using the orthodontic imaging management software was applicable and the 3D printed occlusalsplint was accurate enough for orthognathic surgery.

关 键 词：正畸图像管理软件 正畸-正颌联合治疗 手术(牙合)板 

分 类 号：R783.5[医药卫生—口腔医学]