数字化正颌外科技术在临床实践中面临的挑战  

Challenges of computer-assisted orthognathic surgery in clinical application

作　　者：闫佳恕 李彪[1] 王旭东[1] YAN Jiashu;LI Biao;WANG Xudong(Departments of Oral and Craniomaxillofacial Surgery,Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine&College of Stomatology,Shanghai Jiao Tong University&National Center for Stomatology&National Clinical Research Center for Oral Diseases&Shanghai Key Laboratory of Stomatology&Shanghai Research Institute of Stomatology,Shanghai 200011,China)

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,上海交通大学口腔医学院,国家口腔医学中心,国家口腔疾病临床医学研究中心,上海市口腔医学重点实验室,上海市口腔医学研究所,上海200011

出　　处：《口腔疾病防治》2024年第5期395-400,共6页Journal of Prevention and Treatment for Stomatological Diseases

基　　金：国家自然科学基金项目(82071096);上海“科技创新行动”技术带头人项目(20XD1433100);上海交通大学“交大之星”计划医工交叉研究基金(YG2022ZD014)。

摘　　要：计算机辅助正颌外科经过多年的发展、完善,其优势已被广泛认可,但在临床实际应用中,这项技术仍面临着诸多挑战。从影像数据采集、数字化技术的辅助诊断、数据处理及计算机辅助手术设计,到最后将虚拟方案转移到实际手术中,计算机辅助正颌外科流程中的每一步都可能产生误差,诸多误差的累计、放大,将会影响到最终的手术效果。目前正在探索的误差控制的思路包括:使用数字化设备,例如口内扫描仪;使用自动化方法和算法;使用个性化的骨块定位方式等。同时,术后软组织的精准模拟、下颌骨功能性运动评估、可吸收内固定材料等难题尚未得到完善的解决。只有充分理解当下计算机辅助正颌外科存在的不足之处,才能为继续优化现有方法提供方向,同时在临床实际工作中规避潜在的风险,充分发挥其优势,得到最佳的治疗效果。个体化钛板、人工智能和手术机器人等新技术的应用与发展,将进一步推动本学科的发展,期待未来数字化正颌外科技术在自动化、智能化、个性化方面的革新。After years of development,the advantages of computer-assisted orthognathic surgery have been widely recognized.However,the clinical application of this technology is challenging.Each step may generate errors from data acquisition,computer-assisted diagnosis,and computer-assisted surgical design,causing errors to be transferred from the virtual surgical plan to the operation.The accumulation and amplification of errors will affect the final surgical effect.Currently,digital devices,such as intraoral scanners,are being explored for error control,utilizing automation methods and algorithms,and implementing personalized bone positioning methods.Moreover,there are still many problems that have not been fully resolved,such as precise simulation of postoperative soft tissue,functional assessment of mandibular movement,and absorbable internal fixation materials.Fully understanding computer-assisted orthognathic surgery′s limitations could provide direction for optimizing existing methods while helping clinicians avoid risks and maximize its advantages to achieve the best outcome.Many emerging and cutting-edge technologies,such as personalized titanium plates,artificial intelligence,and surgical robots,will further promote the development of this discipline.We can expect future optimization of digital orthognathic surgical technology by innovations in automation,intelligence,and personalization.

关 键 词：正颌外科 口腔外科 牙颌面畸形 计算机辅助设计 计算机辅助手术 三维打印 计算机模拟 人工智能 数字化设备 可视化 

分 类 号：R78[医药卫生—口腔医学]