虚拟手术设计应用于L形颧骨颧弓缩窄术中的精确性研究  

The accuracy of virtual surgical planning assisted management for L-shaped reduction malarplasty

作　　者：孙晓爽 葛涵 赵庆 高鹤友 周子航 叶斌[1] 李继华[1] Sun Xiaoshuang;Ge Han;Zhao Qing;Gao Heyou;Zhou Zihang;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及关节外科,成都610041

出　　处：《中华整形外科杂志》2025年第1期38-46,共9页Chinese Journal of Plastic Surgery

基　　金：2024年四川省科技厅重点研发项目(24ZDYF0402)。

摘　　要：目的探讨虚拟手术设计应用于L形颧骨颧弓缩窄术中的精确性。方法回顾性分析2018年1月至2020年12月于四川大学华西口腔医院正颌及关节外科诊断为颧骨颧弓过突或颧骨肥大的成年女性患者资料。患者分别采用虚拟手术设计和三维打印钛导板的数字化方法(数字化组)或传统手术方法(对照组)进行L形颧骨颧弓缩窄术,即于颧骨体处行L形截骨,根据术前设计的需要选择切除或不切除L形长臂的部分骨质,颧弓根处形成榫卯关节结构。统计分析2组术后并发症情况及患者术后1年满意度[采用利克特量表,评分1~5分,分别代表非常不满意、不满意、一般、满意、非常满意,满意率=(非常满意+满意)例数/总例数×100%]。通过三维头影测量,对比分析数字化组和对照组的颧骨颧弓复合体在术后三维方向上对称性的差异。将数字化组术前设计模型和术后1周实际模型进行拟合对比,定量分析评价虚拟手术设计在L形颧骨颧弓缩窄术中的精确性。使用SPSS 24.0软件进行统计分析,2组术后总并发症发生率及满意率比较采用χ2检验,2组双侧各标志点在三维方向上的对称性比较采用独立样本t检验,数字化组术前后测量指标比较采用配对样本t检验。结果共纳入78例患者,数字化组36例,年龄(25.2±3.6)岁;对照组42例,年龄(24.3±2.8)岁。术后所有患者面部轮廓均得到明显改善。与对照组相比,数字化组患者并发症发生率较低[25%(9/36)比55%(23/42)],满意率较高[78%(28/36)比48%(20/42)],差异有统计学意义(P均<0.01)。2组患者术后各标志点在三维方向上的对称性测量分析中,数字化组的双侧颧骨体最下点(Zb)在水平向、垂直向、矢状向3个方向上的坐标差值(ΔZb)[(1.05±0.24)、(1.05±0.24)、(1.00±0.88)mm]均明显小于对照组[(2.03±0.58)、(1.32±0.68)、(1.47±0.47)mm],差异有统计学意义(P均<0.05)。数字化组术前设计模型与术后实际模ObjectiveTo evaluate the accuracy of L-shaped reduction malarplasty under the guidance of virtual surgical planning(VSP).MethodsThe data of adult female patients who were diagnosed with zygomatic protrusion or hypertrophy at Department of Orthognathic and Temporo-mandibular Joint Surgery,West China Hospital of Stomatology,Sichuan University,from January 2018 to December 2020 were analyzed retrospectively.L-shaped reduction malarplasty with or without bone resection and with the mortice and tenon joint structure on the zygomatic arch was conducted either by digital procedures comprising VSP and three-dimensional printing titanium templates(digtal surgery group)or by conventional method(control group).The incidence of postoperative complications and the patient postoperative satisfaction[using a Likert scale with a score ranging from 1 to 5,representing very dissatisfied,dissatisfied,average,satisfied and very satisfied,satisfaction rate=(very satisfied+satisfied)/total number of patients×100%]were statistically analyzed in the two groups.The differences in the postoperative symmetry of the zygomatic complex between the digital group and the control group were analyzed by three-dimensional cephalometry.The accuracy of VSP in L-shaped reduction malarplasty was evaluated by comparing the preoperative design model with the actual postoperative model in the digital group.The statistical analyses were conducted using SPSS 24.0 software.The chi-square test was used in the comparison of surgical complications and patient satisfaction rates.The symmetry of bilateral landmarks in the three-dimensional direction between the two groups was evaluated using the independent t-test,and the pre-and post-operative measurements in the digital group were compared using paired t-test.ResultsA total of 78 patients were included,with 36 in the digital group,aged(25.2±3.6)years,and 42 in the control group,aged(24.3±2.8)years.Satisfactory reduction of zygomatic protrusion or hypertrophy was recognized among all patients.Compared with t

关 键 词：正颌外科学 颧骨颧弓缩窄术 L形截骨术 虚拟手术设计 三维打印 三维分析 精确性 

分 类 号：R782[医药卫生—口腔医学]