数字化3D仿真模型辅助精准化整复颅眶畸形的效果评价

doi:10.19438/j.cjoms.2019.06.006

中国口腔颌面外科杂志 ›› 2019, Vol. 17 ›› Issue (6): 513-517.doi: 10.19438/j.cjoms.2019.06.006

数字化3D仿真模型辅助精准化整复颅眶畸形的效果评价

江灿洋, 黄建平, 江燕, 施斌, 黄立^*, 林李嵩^*

福建医科大学附属第一医院口腔颌面外科,福建医科大学面部整复与重建研究室,福建省颌面医学中心,福建福州 350005

收稿日期:2019-05-05 出版日期:2019-11-20 发布日期:2019-12-16
通讯作者: 黄立,E-mail:13599979505@163.com;林李嵩,E-mail:dr_lls@163.com。*共同通信作者
作者简介:江灿洋（1989-）,男,硕士,住院医师,E-mail:568922632@qq.com 。
基金资助:
福建省科技计划引导项目（2018Y0026）; 福建省卫生计生中青年骨干人才培养项目（2016-ZQN-48）; 福建省卫计委创新课题（2018-CX-27）; 福建医科大学启航基金（2018QH1076）

Evaluation of digital 3D simulation model assisted in the precise reconstruction of cranio-orbital deformities

JIANG Can-yang, HUANG Jian-ping, JIANG Yan, SHI Bin, HUANG Li, LIN Li-song

Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Fujian Medical University. Fuzhou 350005, Fujian Province, China

Received:2019-05-05 Online:2019-11-20 Published:2019-12-16

摘要/Abstract

摘要： 目的: 探讨数字化仿真3D模型在颅眶畸形精准化整复术中的应用效果。方法: 收集2013年1月—2019年1月福建医科大学附属第一医院收治的44例颅眶畸形病例：创伤性颅眶畸形43例和先天性颅眶畸形1例;将创伤性患者分为传统组和模型组。除传统组外,所有患者术前均进行头颅螺旋CT薄层扫描（层厚≤1.0 mm）。采集原始DICOM数据,利用计算机数字化软件重建头颅三维数据（STL格式）,并通过快速成型技术和反求镜像工程技术制作头颅3D仿真模型。术前利用数字化软件模拟手术过程,并在模型上进行手术演练、预弯或预制植入材料,术中指导手术入路和解剖部位的确认。术后收集手术时间、颅眶对称性和满意度。采用SPSS 25.0软件包对数据进行统计学处理。结果: 随访3个月~6 a,所有患者均未出现颅内血肿、颅内感染、失明、脑疝、嗅觉丧失等严重并发症;仅1例出现脑脊液鼻漏,经保守治疗后痊愈。模型组手术时间显著少于传统组（P<0.05）,模型组的术后满意程度和对称性显著优于传统组（P<0.05）。结论: 数字化3D仿真模型能够提供精准的诊疗信息,为精准、安全整复颅眶畸形提供有利的手术条件,提高手术效率,改善患者颅颌面部外形,具有一定的临床应用价值。

关键词: 颅眶畸形, 数字精准化整复, Crouzon综合征

Abstract: PURPOSE: To explore the clinical value of digital 3D simulation model in precise reconstruction of cranio-orbital deformities. METHODS: A retrospective analysis was performed in 44 cases with cranio-orbital malformation from January 2013 to January 2019, 43 had traumatic cranio-orbital deformity and 1 was with congenital cranio-orbital malformation. Among them, patients with deformity were further divided into traditional group and model group. In addition to the traditional group, all patients underwent a thin-slice scan of the skull spiral CT (layer thickness<1.0 mm) preoperatively, the original DICOM image data were collected, and skull three-dimensional data (STL format) were reconstructed by computer digital software. Through rapid prototyping technology and reverse mirror engineering technology, STL data were imported to produce 3D simulation model. The surgical procedure was simulated by using digital software before surgery, and surgical exercises, pre-bending or pre-implantation materials were performed on the model, to guide the surgical approach and anatomical sites were confirmed during operation. The operation time, symmetry and satisfaction were collected postoperatively, the data was statistically processed using SPSS 25.0 software package. RESULTS: All patients were followed up for 3 months to 6 years, no serious complications such as intracranial hematoma, intracranial infection, blindness, cerebral hernia, and olfactory loss were noted, only 1 patient had cerebrospinal fluid rhinorrhea and recovered after conservative treatment. The operation time of the model group was significantly lower than that of the traditional group (P<0.05). The postoperative satisfaction degree and symmetry of the model group were significantly better than the traditional group (P<0.05). CONCLUSIONS: Digital 3D simulation model provides accurate medical information before surgery, improving the efficiency and accuracy of surgery and craniofacial shape of the patients.

Key words: Cranio-orbital deformities, Digital precise reconstruction, Crouzon syndrome

中图分类号:

R782.2

江灿洋, 黄建平, 江燕, 施斌, 黄立, 林李嵩. 数字化3D仿真模型辅助精准化整复颅眶畸形的效果评价[J]. 中国口腔颌面外科杂志, 2019, 17(6): 513-517.

JIANG Can-yang, HUANG Jian-ping, JIANG Yan, SHI Bin, HUANG Li, LIN Li-song. Evaluation of digital 3D simulation model assisted in the precise reconstruction of cranio-orbital deformities[J]. China J Oral Maxillofac Surg, 2019, 17(6): 513-517.

参考文献

[1] 俞哲元, 曹德君, 柴岗, 等. 计算机辅助设计定制化植入体在复杂眶周畸形治疗中的应用[J]. 组织工程与重建外科杂志, 2014, 10(1): 22-25.
[2] 王勇, 战云, 史锡文, 等. 颅脑损伤后眶顶骨折一期重建15例临床分析[J]. 中华神经外科杂志, 2013, 29(3): 267-269.
[3] 安金刚. 颅颌面坚强内固定(十七)额窦骨折的诊断及治疗[J].中华口腔医学杂志, 2014, 49(6): 375-378.
[4] 施斌, 林李嵩, 邱宇, 等. 快速原型技术在下颌骨个性化重建中的应用[J]. 福建医科大学学报, 2009, 43(3): 252-254.
[5] 欧飞, 段世均, 张金鸽, 等. 颅颌面部畸形个体数字化修复技术的临床应用[J]. 中国组织工程研究与临床康复, 2010, 14(22): 4032-4035.
[6] 彭雅滨, 毛小林, 王晓峰, 等. 数字化三维重建钛网在大面积颅骨缺损修补中的应用[J]. 中国组织工程研究与临床康复, 2010, 14(26): 4760-4763.
[7] 王兴, 张志愿. 口腔颌面外科临床解剖学 [M]. 济南: 山东科学技术出版社, 2011: 486-490.
[8] Komuro Y, Nishida M, Imazawa T, et al.Combined frontal bone reshaping and forehead lift for frontal sinus hypertrophy[J]. Aesthet Plast Surg, 1999, 23(5): 361-363.
[9] Nahabedian MY, Al-Shunnar B, Manson PN.Correction of frontal bone hypertrophy with setback osteotomy and hydroxyapatite cement[J]. Ann Plast Surg, 2000, 44(5): 567-568.
[10] Yang B, Dong X, Zhang ZY, et al.Fronto-orbital osteotomy reshaping for supraorbital ridge protrusion[J]. J Craniofac Surg, 2015, 26(6): 1926-1929.
[11] Jurlina M, Janjanin S, Melada A, et al.Large intracranial intradural mucocele as a complication of frontal sinus osteoma[J]. J Craniofac Surg, 2010, 21(4): 1126-1129.
[12] Akay KM, Ongürü O, Sirin S, et al.Association of paranasal sinus osteoma and intracranial mucocele-two case reports[J]. Neurol Med Chir (Tokyo), 2004, 44(4): 201-204.
[13] 江灿洋, 林李嵩. 累及颅底的颅颌面肿瘤切除后缺损重建的临床分析[D].福州: 福建医科大学, 2016.
[14] Eolchiyan SA.[Complex skull defects reconstruction with САD/САМ titanium and polyetheretherketone (PEEK) implants][J]. Zh Vopr Neirokhir Im N N Burdenko, 2014, 78(4): 3-13.
[15] Eppley BL.Craniofacial reconstruction with computer-generated HTR patient-matched implants: use in primary bony tumor excision[J]. J Craniofac Surg, 2002, 13(5): 650-657.
[16] Eufinger H, Weihe S, Scherer P, et al.Management of cranial and craniofacial bone defects with prefabricated individual titanium implants: follow-up and evaluation of 166 patients with 169 titanium implants from 1994 to 2000[J]. Int J Comp Ass Radiol Surg, 2006, 1(4): 197-203.
[17] Kuttenberger J, Hardt N.Long-term results following reconstruction of craniofacial defect with titanium micro-mesh system[J].J Craniomaxillofac Surg, 2001, 29(2): 75-81.
[18] Scolozzi P, Martinez A, Jaques B.Complex orbito-fronto-temporal reconstruction using computer-designed PEEK implant[J]. J Craniofac Surg, 2007, 18(1): 224-228.
[19] Staffa G, Barbanera A, Faiola A.et al.Custom made bioceramic implants in complex and large cranial reconstruction: A two-year follow-up[J]. J Craniomaxillofac Surg, 2012, 40(3): e65-e70.
[20] William DF, McNamara A. Potential of polyetheretherketone (PEEK) and carbon-fibre-reinforced PEEK in medical application[J]. J Mater Sci Lett, 1987, 6(2): 188-190.
[21] Cabraja M, Klein M, Lehmann TN.Long-term results following titanium cranioplasty of large skull defects[J]. Neurosurg Focus, 2009, 26(6): e10.
[22] Hull CW. Apparatus for production of three-dimensional objects by stereolithography: US, 4,575,330 [P].1986-03-11.
[23] 张纯妍, 聂鑫. 3D打印技术在颅颌面创伤应用的相关技术与发展趋势[J].创伤外科杂志, 2018, 20(1): 67-71.
[24] 付梦瑶, 杨斌. 3D生物打印在骨缺损修复重建中的应用进展[J]. 中华医学美学美容杂志, 2018, 24(3): 157-159.
[25] Mironov V, Trusk T, Kasyanov V, et al.Biofabrication: a 21st century manufacturingparadigm[J]. Biofabrication, 2009, 1(2): 022001.
[26] 张智勇, 冯志强, 巩玺, 等. 计算机导航在单侧眼眶骨折眶壁重建中的应用评价[J]. 中华口腔医学杂志, 2012, 47(11): 657-661.
[27] Lubbers HT, Jacobsen C, Matthews F, et al.Surgical navigation in craniomaxillofacial surgery: expensive toy or useful tool? A classification of different indications[J]. J Oral Maxillofac Surg, 2011, 69(1): 300-308.
[28] Jalbert F, Boetto S, Nadon F, et al.One-step primary reconstruction for complex craniofacial resection with PEEK custom-made implants[J].J Craniomaxillofac Surg, 2014, 42(2): 141-148.

数字化3D仿真模型辅助精准化整复颅眶畸形的效果评价

Evaluation of digital 3D simulation model assisted in the precise reconstruction of cranio-orbital deformities

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