两种数字化下颌角截骨导板的设计与临床应用效果比较  

Comparison of design and clinical outcomes of two different digital osteotomy template for mandibular angle osteotomy

作　　者：胡超 吴国平[1] 上官文松 张文文[1] 王树 卢通 高升 谢知洋 乔祥 赵杨[1] Hu Chao;Wu Guoping;Shangguan Wensong;Zhang Wenwen;Wang Shu;Lu Tong;Gao Sheng;Xie Zhiyang;Qiao Xiang;Zhao Yang(Department of Plastic Surgery,the Friendship Plastic Surgery Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学友谊整形外科医院整形外科,南京210029

出　　处：《中华整形外科杂志》2022年第4期392-398,共7页Chinese Journal of Plastic Surgery

摘　　要：目的比较2种数字化下颌角截骨导板的准确性和临床应用效果。方法以2019年3月至2020年7月南京医科大学友谊整形外科医院同一手术小组收治的女性下颌角肥大患者为研究对象,按入院顺序交替分配到A、B 2组,A组为常规导板组,B组为新式导板组。所有患者术前均进行锥形束CT(CBCT)扫描及三维重建。术前将获得的CT数据导入Mimics 19.0,针对患者情况和要求设计个性化下颌角截骨线和截骨导板。A组以下颌骨截除部分设计截骨导板(常规导板),B组以下颌骨保留部分设计截骨导板(新式导板),并三维打印出截骨导板。所有患者经口内切口入路,术中用截骨导板引导双侧下颌角弧形截骨。术后1周内同样对所有患者行CBCT扫描,并观察患者切口愈合、并发症发生情况及下面部形态。比较2组单侧置入导板到完成下颌角弧形截骨时间、术后单侧24 h引流量及术前设计与术后1周内三维重建模型下颌下缘的偏差。结果共纳入20例女性下颌角肥大患者,其中A组10例,年龄(24.3±2.3)岁(20~31岁);B组10例,年龄(24.6±2.2)岁(22~30岁)。2组患者年龄比较,差异无统计学意义(P>0.05)。所有患者均顺利完成下颌角截骨,无骨折、大出血、感染等并发症发生,术后效果均满意。A组单侧置入导板到完成下颌角弧形截骨时间为(18.1±1.0)min,明显长于B组的(14.2±1.4)min(P<0.05)。A组和B组术后单侧24 h引流量分别为(107.9±12.5)ml和(112.1±13.8)ml(P>0.05)。术前设计与术后下颌下缘的偏差:A组下颌下缘前部偏差值为(2.7±1.2)mm,明显大于B组的(1.6±0.9)mm(P<0.05);A、B 2组中部偏差值分别为(1.9±0.7)mm和(1.8±0.8)mm,两者比较差异无统计学意义(P>0.05);A组后部偏差值为(2.8±1.1)mm,明显大于B组的(1.8±0.8)mm(P<0.05)。结论数字化截骨导板辅助下颌角截骨术,可以实现精确截骨,降低手术难度;新式截骨导板在术中就位更容易,固定更稳定,手术效率和截�Objective To evaluate the accuracy and clinical outcomes of two different three-dimensional(3D)printed digital mandibular angle osteotomy templates.Methods Female patients with a prominent mandibular angle(PMA)admitted to the same surgical team in the Friendship Plastic Surgery Hospital of Nanjing Medical University from March 2019 to July 2020 were selected as the research subjects.They were allocated into Group A and Group B alternately according to the order of admission.Group A was the conventional digital osteotomy template(CDOT)group,and Group B was the novel digital osteotomy template(NDOT)group.All patients underwent cone-beam computed tomography(CBCT)scan and 3D reconstruction before surgery.Preoperative CT data were imported into Mimics 19.0,and personalized mandibular angle osteotomy(MAO)line and digital osteotomy template(DOT)were designed according to patients’conditions and requirements.In Group A,the DOTs were designed according to the part of mandibular angle to be removed(CDOT).And in Group B,the DOTs were designed according to to the part of reserved mandible(NDOT).The DOTs were created with a 3D printer.All patients were underwent bilateral MAO under the guidance of these DOTs through an intraoral approach.CBCT scan was also performed on all patients within 1 week after surgery,and incision healing,complications and lower facial contouring were observed.The mean time taken for positioning DOT and performing curved osteotomy,the volume of postoperative drainage on one side within 24 hours after surgery,and the deviations between the preoperative design and 3D reconstruction mode lower mandibular margin within 1 week after surgery were compared between the two groups.Results A total of 20 female patients with PMA were included,including 10 patients in Group A,aged 20-31 years,with an average of 24.3±2.3 years.Group B consisted of 10 patients aged 22-30 years,with an average of 24.6±2.2 years.There was no significant difference in age between 2 groups(P>0.05).All patients were successfully per

关 键 词：截骨术 计算机辅助设计 下颌角肥大 数字化手术导板 三维打印 

分 类 号：R782.2[医药卫生—口腔医学]