中国实用口腔科杂志

中国实用口腔科杂志

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数字化软件辅助设计在治疗偏颌畸形患者中的应用效果研究

王雪1a，张桂荣2，杨鸣良1b，颜光启1b，周青1b   

  1. 1. 中国医科大学口腔医学院·附属口腔医院a 正畸科，b 口腔颌面外科，辽宁  沈阳  110002；2. 沈阳市口腔医院，辽宁  沈阳  110002
  • 出版日期:2019-07-15 发布日期:2019-08-28
  • 基金资助:

    沈阳市科技计划项目（17-230-9-11）

  • Online:2019-07-15 Published:2019-08-28

摘要：

目的　评价数字化软件辅助设计在治疗偏颌畸形患者中的应用效果。方法　选择2016年9月至2018年9月于中国医科大学附属口腔医院口腔颌面外科就诊的偏颌畸形患者18例。所有患者术前完成三维CT检查和牙列石膏模型的光学扫描，将数据分别以DICOM格式和STL格式传送至数字化工作站。在数字化软件中构建坐标系，重建上下颌骨、血管和神经束，并完成正颌外科的手术模拟预测，最后设计并打印患者上颌骨的截骨导板、复位导板和终末咬合导板。所有患者在术后6个月到口腔颌面外科门诊复查并行上下颌骨三维CT检查。利用数字化软件测量术后6个月患者两侧上颌第一磨牙点和尖牙点到眶耳平面和冠状平面的距离，计算非对称率；测量上中切牙点和颏顶点到正中矢状面距离作为术后效果的评价指标。结果　术后6个月患者两侧上颌第一磨牙点到眶耳平面和冠状平面距离的非对称率分别为（1.8 ± 1.0）%和（3.2 ± 1.7）%；两侧上颌尖牙点到眶耳平面和冠状平面距离的非对称率分别为（1.0 ± 0.8）%和（11.0 ± 4.8）%；上中切牙点和颏顶点到正中矢状面距离分别为（0.84 ± 1.05）mm和（1.49 ± 1.23）mm。所有患者均对面型表示满意。结论　数字化软件的模拟设计能够提高手术安全性，确保术中操作的精度，提高患者术后美学效果。因此，数字化软件辅助设计在治疗偏颌畸形患者中的应用具有重要的临床意义。

关键词: 数字化技术, 偏颌畸形, 正颌外科, 三维CT

Abstract:

Objective　To evaluate the application effect of digital-software-assisted design on patients with asymmetry deformities. Methods　A total of 18 patients with facial deformities who were treated in the Department of Oral and Maxillofacial Surgery，Hospital of Stomatology，China Medical University，between Sep. 2016 and Sep. 2018 were collected. All the patients underwent three-dimensional computed tomography scan and optical scan for their plaster models and the DICOM and STL format data were transformed to the digital workstation respectively. First，the maxilla and mandible together with nerves and vessels were rebuilt respectively by digital software. Then simulation and virtual osteotomies for operations were performed. Finally，surgical cutting and repositioning templates together with occlusal splints were designed and printed by three-dimensional printer. All the patients went to outpatient clinic of Oral and Maxillofacial Surgery 6 months after operation for clinical examination and rescan of three-dimensional computed tomography. The postoperative evaluation parameters included asymmetric index（Q）and the distances from UI and P points to midsagittal plane. Q meant bilateral asymmetric index which included the difference in the value of distances from bilateral upper first molar and canine points to Frankfort and coronal plane. Results　The Q for the distances from bilateral upper first molar points to Frankfort and coronal plane were（1.8 ± 1.0）% and（3.2 ± 1.7）%. The Q for the distances from bilateral canine points to Frankfort and coronal plane were（1.0 ± 0.8）% and（11.0 ± 4.8）%. The distances from UI and P points to midsagittal plane were（0.84 ± 1.05）mm and（1.49 ± 1.23）mm. All patients were satisfactory with their final facial patterns. Conclusion　Digital-software-assisted design for treating patients with asymmetry deformities can increase procedure safety，ensure the accuracy of treatment and improve postoperative aesthetic effect in patients. Therefore，it is of important clinical significance in the treatment of patients with asymmetry deformities.

Key words: digital technique, asymmetry deformity, orthognathic surgery, three-dimensional computed tomography