数字化正颌外科技术在半侧颜面短小畸形矫治中的应用  

Application of digital orthognathic surgery in the correction of hemifacial microsomia

作　　者：万启龙 谭晶晶 吴姝萱 李锋 杨学文 李祖兵 Wan Qilong;Tan Jingjing;Wu Shuxuan;Li Feng;Yang Xuewen;Li Zubing(Department of Orthognathic&Cleft Lip and Palate Plastic Surgery,Hospital of Stomatology,Wuhan University,Wuhan 430079,China;Department of Oral and Maxillofacial Trauma and Temporomandibular Joint Surgery,Hospital of Stomatology,Wuhan University,Wuhan 430079,China)

机构地区：[1]武汉大学口腔医院正颌与唇腭裂整形外科,武汉430079 [2]武汉大学口腔医院口腔颌面创伤与颞下颌关节外科,武汉430079

出　　处：《中华整形外科杂志》2022年第1期24-31,共8页Chinese Journal of Plastic Surgery

基　　金：武汉市科技局应用基础研究计划(2017060201010187)。

摘　　要：目的探讨数字化正颌外科技术在半侧颜面短小畸形(HFM)患者正颌手术矫治中的应用效果及患者满意度。方法回顾性分析2017年1月至2020年5月武汉大学口腔医院正颌与唇腭裂整形外科收治的HFM患者的临床资料。术前应用数字化正颌外科技术设计手术方案,三维打印中间导板及终末导板用于术中定位上、下颌骨含牙骨块的位置。术后第5天拍摄面部标准照和头颅CT,与术前设计方案拟合,以测量上颌骨各标志点及颏前点术后实际位置和术前设计位置与参考平面距离的误差,数据以±s表示,采用配对t检验进行比较,P<0.05表示差异有统计学意义。采用间隔尺度法调查患者术后第7天及6个月的满意度(满分为100分)。结果共纳入9例HFM患者,男5例,女4例,年龄(25.8±3.8)岁。其中患侧位于左侧6例,位于右侧3例。所有患者手术实施顺利,术中导板就位良好,上、下颌骨含牙骨块按照术前设计的位置准确移动并固定,术中未发生颌骨意外骨折等情况。术后5 d拍摄的面部标准照和CT显示,患者口颌系统功能恢复良好,无明显并发症发生。上颌骨各标志点及颏前点术后实际位置和术前设计位置与参考平面距离的误差,差异均无统计学意义(P>0.05),其中上颌骨左侧第一磨牙近中颊尖点误差最大,为(0.92±0.34)mm。患者术后第7天满意度评分为(83.2±2.7)分,术后6个月评分为(73.8±2.5)分。结论数字化正颌外科技术能够精确指导手术,有效矫正HFM患者咬合平面、牙列中线及颏中线偏斜等畸形,患者术后初期满意度较高,但6个月后有所下降。Objective To evaluate the effectiveness of digital orthognathic surgery in the surgical treatment of patients with hemifacial microsomia(HFM)and patients’satisfaction.Methods The clinical data of HFM patients admitted to the Department of Orthognathic&Cleft Lip and Palate Plastic Surgery,Hospital of Stomatology,Wuhan University,from January 2017 to May 2020 were retrospectively analyzed.The digital orthognathic surgery was used to design surgical protocols before surgery.The intermediate wafer and terminal wafer by three-dimensional printing were applied to determine the position of maxillary and mandible bone blocks.The distance change between landmarks in maxillary and chin and the reference planes was measured.The skull CT and face photographs were taken 5 days after surgery to compare the distance between the actual position and the designed position.Data were expressed as the Mean±SD and analyzed by the pairing t-test with P<0.05 considered statistically.The patients’satisfaction was investigated by interval scale method on day 7 and 6 months after operation.Results There were 9 HFM patients in this study,included 5 men and 4 women,and the average age was 25.8±3.8 years old.6 patients were affected on the left side and 3 patients was affected on the right side.All the operations were processed successfully.The wafers were in good position that the maxillary and mandible blocks were moved precisely according to the digital design.There were no accidental fractures of the jaw during the operation.The post-operative photographs and CT showed the stomatognathic system recovered well without serious postoperative complications.The errors between postoperative situation and preoperative designed situation in maxillary and chin were no statistically difference(P>0.05).The maximum movement error of the maxillary bone block was the mark point of the first molar on the left,with an average error of(0.92±0.34)mm.The patients’satisfaction scores were averaged 83.2±2.7 points on day 7 after surgery,while the sc

关 键 词：计算机辅助设计 正颌外科 半侧颜面短小畸形 三维打印 手术误差 

分 类 号：R782.2[医药卫生—口腔医学]