数字化外科用于上颌Le FortⅠ型分块骨切开术的效果及精确度评价  

The surgical results and accuracy evaluation of virtual surgical planning in segmental Le FortⅠ surgery

作　　者：魏一源 孙晓爽 赵庆 吴一凡 葛涵 叶斌[1] 李继华[1] Wei Yiyuan;Sun Xiaoshuang;Zhao Qing;Wu Yifan;Ge Han;Ye Bin;Li Jihua(State Key Laboratory of Oral Diseases,National Clinical Research Center for Oral Diseases,Department of Orthognathic and Temporo-Mandibular Joint Surgery,West China Hospital of Stomatology,Sichuan University,Chengdu 610041,China)

机构地区：[1]口腔疾病研究国家重点实验室,国家口腔疾病临床医学研究中心,四川大学华西口腔医院正颌与关节外科,成都610041

出　　处：《中华整形外科杂志》2024年第3期264-272,共9页Chinese Journal of Plastic Surgery

摘　　要：目的探讨数字化外科导板和板引导下的Le FortⅠ型分块骨切开术的精确度及手术效果。方法回顾性分析2014年1月至2019年6月,在四川大学华西口腔医院正颌与关节外科行Le FortⅠ型分块骨切开术的患者临床资料。根据术前手术方案设计方法分为数字化外科组和传统模型外科组。通过对数字化外科组术前设计模型及术后模型的拟合比对、定量分析评价虚拟手术设计的精确性,分析传统模型外科组及数字化外科组的上颌骨术前术后在三维方向上的手术位移量、术后并发症发生情况,以及患者术后半年满意度调查。使用SPSS 22.0进行统计分析,对数字化外科组术前设计模型与实际术后模型之间的线性距离和角度采用配对t检验,数字化外科组和传统模型外科组患者各个标志点术前术后在三维方向上的位移量采用独立样本t检验,并对2组术后并发症发生比例采用Pearson卡方检验,以P<0.05为差异有统计学意义。结果共纳入221例患者,数字化外科组129例,男35例,女94例,年龄为(24.5±6.5)岁;传统模型外科组92例,男28例,女性64例,年龄为(27.7±5.4)岁。数字化外科组中术前设计模型与实际术后模型之间线性距离差为(1.23±0.35)mm,角度差为2.48°±0.31°。术后平均随访9个月,2组患者上颌骨术前、术后在三维方向上的手术位移量测量中,数字化外科组与传统模型外科组右上颌尖牙牙尖点、左上颌第1磨牙近中颊尖点(U3R、U6L)在垂直方向上的位移量分别比较[(6.72±1.57)mm vs.(4.07±2.14)mm、(4.73±2.07)mm vs.(1.62±1.82)mm],差异均有统计学意义(P均<0.05)。数字化外科组除1例牙根损伤外,无其他严重并发症发生;传统模型外科组则出现3例腭瘘,4例牙根损伤,2例骨不连,其手术并发症发生比例明显高于数字化外科组[(9.8%,9/92)vs.(0.8%,1/129)],差异有统计学意义(P<0.05)。数字化外科组术后94.5%(122/129)的患者满意度评分>3分Objective In this retrospective study,the accuracy and outcomes of segmental Le Fort I surgery with the aid of 3D-printed surgical templates and occlusal splints and dental model surgery were evaluated.Methods Clinical data of patients receiving segmental Le Fort I surgery in the Department of Orthognathic and Temporo-Mandibular Joint Surgery of West China Stomatological Hospital of Sichuan University from January 2014 to June 2019 were retrospectively analyzed.The accuracy of virtual surgical planning(VSP)and the difference between VSP and dental model surgery were evaluated by postoperative complications,color distance maps,and quantitative accuracy analysis.The amount of surgical displacement of the maxilla in the three-dimensional direction before and after surgery,the occurrence of postoperative complications and the patients'satisfaction survey were analyzed in both groups.Paired t-tests were used for the linear distance and angle between the preoperative design model and the final virtual surgery model in the digital surgery group.Independent samples t-test was used for each marker point’s preoperative and postoperative displacements in the three-dimensional direction between the digital surgery group and the dental model group.The proportion of postoperative complications in the 2 groups was tested using the Pearson chi-square test,and the difference was considered statistically significant at P<0.05.Results There were 129 patients in the digital surgery group,35 males and 94 females,aged(24.5±6.5)years,and 92 patients in the dental model surgery group,28 males and 64 females,aged(27.7±5.4)years.The overall mean linear difference was 1.23±0.35 mm,and the overall mean angular difference was 2.48°±0.31°.The vertical displacement of U3R,U6L in the digital surgery group was(6.72±1.57)mm and(4.73±2.07)mm.The vertical displacement of U3R,U6L in the group of dental model surgery was(4.07±2.14)mm and(1.62±1.82)mm.The significant deviation difference in U3R-Y and U6L-Y between two groups could be detec

关 键 词：外科手术 计算机辅助 牙颌面畸形 Le FortⅠ型分块骨切开术 虚拟手术 传统模型外科 数字化外科导板 三维分析 

分 类 号：R782[医药卫生—口腔医学]