个性化牙骨支持式截骨导板在双侧下颌矢状劈开截骨术中的应用  

Application of customized dental-bone supported osteotomy guide plate in bilateral sagittal split osteotomy

作　　者：王立冬 马文[1] 付帅[1] 张长彬[1] 崔庆赢 彭灿邦 陈雅琦 黎明[1] WANG Lidong;MA Wen;FU Shuai;ZHANG Changbin;CUI Qingying;PENG Canbang;CHEN Yaqi;LI Ming(Department of Oral and Maxillofacial Surgery,Kunming Medical University School and Hospital of Stomatology,Yunnan Key Laboratory of Stomatology,China,650106)

机构地区：[1]昆明医科大学附属口腔医学院/医院口腔颌面外科,云南省口腔医学重点实验室,650106

出　　处：《实用口腔医学杂志》2024年第5期698-702,共5页Journal of Practical Stomatology

基　　金：云南省昆医联合项目-面上项目(编号:202301AY070001-081);昆明医科大学教育教学研究课题(2023-JY-Y-045)。

摘　　要：目的:探讨个性化牙骨支持式截骨导板在双侧下颌升支矢状劈开截骨术(BSSO)中的应用效果。方法:纳入需行BSSO的牙颌面畸形患者24例(48侧)。行颌面部CT扫描,激光扫描石膏模型建立三维模型。数字化技术制作下颌骨升支内侧水平骨切口及前缘矢状骨切口截骨导板。48侧手术由同一医师术中随机使用(27侧)或不使用导板(21侧)完成,并对完成下颌升支内侧水平骨切口及前缘矢状骨切口(向前约1 cm)的时间进行记录。术后CT复查,按照lingual split scale(LSS)分类来评估手术效果。结果:术后所有患者愈合良好,无明显并发症。导板组和非导板组完成下颌升支内侧水平骨切口及下颌升支前缘矢状骨切口(往前约1 cm)的时间分别为(125.67±2.23)s和(141.15±3.69)s(P<0.05)。使用截骨导板后下颌骨按照Hunsuck标准截骨线劈开的概率由42.86%上升至66.67%,截骨线经过下颌神经管的概率从33.33%下降到7.41%。并且使用截骨导板避免了截骨线LSS4类的发生。数据分析结果显示截骨导板的使用影响下颌升支矢状劈开截骨术裂开方式(P<0.05)。结论:个性化牙骨支持式截骨导板在BSSO中能够帮助医师更好更快的完成截骨,减少手术并发症。Objective:To investigate the effects of customized dental-bone supported osteotomy guide plate in bilateral sagittal split osteotomy.Methods:24 patients(48 sides)with maxillofacial deformity underwent BSSO were included.The maxillofacial region of all patients was scanned by CT,the plaster dental models were scanned using laser surface scanner,and the 3D models were established.The osteotomy guide plates of the inner horizontal and anterior sagittal bone incision of mandible ramus were manufactured by digital technology.All splits underwent operation with(27 side)and without(21 sides)the osteotomy guide plate respectively by the same doctor,and the time for the inner horizontal and anterior sagittal bone incision of mandible ramus was recorded.Postoperative CT scan was performed to evaluate the surgical effects according to the lingual split scale(LSS)classification.Results:The wound in all patients healed well and no serious complication was observed.The time for the inner horizontal and anterior sagittal bone incision of mandible ramus in plate group and no plate group was(125.67±2.23)s and(141.15±3.69)s respectively(P<0.05).The probability of mandible splitting according to Hunsuck standard osteotomy line increased from 42.86%to 66.67%,and the probability of osteotomy line passing through mandibular nerve canal decreased from 33.33%to 7.41%,by using osteotomy guide plate.In addition,LSS4 type of osteotomy line was avoided by using osteotomy guide plates.Data analysis showed that the split pattern of sagittal split osteotomy of the mandibular ramus was influenced by the application of osteotomy guide plates(P<0.05).Conclusion:The customized dental-bone supported osteotomy guide plate is effective in the completion of the operation and reducing time consuming and surgical complication in BSSO.

关 键 词：牙骨支持式手术导板 双侧下颌升支矢状劈开截骨术 计算机辅助技术 三维重建 

分 类 号：R782.2[医药卫生—口腔医学]