理论髁突距的研究及其在颌骨复位重建中的初步应用  

The study of theoretical condyle distance and preliminarily application in mandibular reduction and reconstruction

作　　者：庄海 张金灿 张怡雯 尤莹 朱榴宁 卜寿山 ZHUANG Hai;ZHANG Jincan;ZHANG Yiwen;YOU Ying;ZHU Liuning;BU Shoushan(Department 0f Stomatology,The First Afiliated Hospital with Nanjing Medical Unirersity,Nanjing 210000,China)

机构地区：[1]南京医科大学第一附属医院口腔科,江苏南京210000

出　　处：《口腔医学》2021年第5期445-449,共5页Stomatology

基　　金：国家自然科学基金面上项目(81670967)。

摘　　要：目的通过对颌骨解剖标志的三维测量分析获得理论髁突距(TCoD),用于颌骨复位重建中确定下颌骨宽度。方法收集100例正常颌骨CBCT数据,将Dicom数据导入Mimics中,重建后对6个骨性标志进行标记,并获得12个线性和角度变量。通过Spss软件对数据进行统计分析,获得TCoD。通过10例下颌骨折病例的回顾分析验证可行性。并在临床中指导1例下颌骨骨折复位。结果不同性别、个体角度变量的差异通常小于长度变量,升支高度和下颌角的总体变异系数(COV)最大。但是,关节窝距(FoD)与髁突距(CoD)具有高度的一致性,50岁以下CoD等于FoD(P>0.05)。并且CoD与FoD之差与年龄存在线性关系(P<0.05),因此在50岁以上的患者可以通过修正获得TCoD。通过10例骨折患者术后回顾分析,TCoD与FoD相比更接近术后髁突距。1例下颌骨粉碎性骨折的无牙颌患者,进行术前虚拟手术通过TCoD对下颌骨复位重建进行指导和验证,获得满意效果。结论理论髁突距可以作为确定下颌骨宽度的理想参数。Objective To obtain the theoretical condyle distance(TCoD) which was applied to determine the width of the mandible in mandibular reduction and reconstruction through three-dimensional measurement and analysis of jaw anatomical landmarks. Methods The archived CBCT images of 100 cases of normal jaws were imported into mimics to establish jaw model. Then 6 bony landmarks were marked, and 12 linear and angular variables were measured. The data were statistically analyzed via Spss software to obtain parameters for mandibular reduction and reconstruction. The feasibility was verified by a retrospective analysis of 10 cases of mandibular fracture, and it was used to guide 1 case of mandibular fracture reduction in the clinic. Results The discrepancy in angle variables of different genders and individuals was usually smaller than the length variable, and the COV in ramus height and gonial angle was the largest. However, there was a high degree of consistency between fossa distance(FoD) and condyle distance(CoD). The FoD was equal to CoD(P>0.05) in patients under 50 years old. There was a linear relationship between FoD and CoD(P<0.05), so patients above 50 years old could obtain the TCoD through correction. Through retrospective analysis of 10 fracture patients, compared with FoD, the theoretical condyle distance was closer to the postoperative condyle distance. On an edentulous patient with a comminuted mandibular fracture, preoperative virtual surgery was performed. The reduction and reconstruction of the mandible was guided and verified via TCoD, and satisfactory results were obtained. Conclusion TCoD can be used as an ideal parameter for determining the width of the mandible.

关 键 词：理论髁突距 数字化技术 下颌骨宽度 下颌骨粉碎性骨折 

分 类 号：R782.4[医药卫生—口腔医学]