CAJ | 학술논문

目的：应用计算机辅助的三维影像重建及测量技术，评估牵引成骨矫治中面部发育不良畸形的手术疗效。方法自2005年至2010年，对11例严重中面部发育不良患者，采用Le FortⅢ型颅面部截骨和牵引成骨术进行治疗，术前、术后运用计算机辅助的三维影像测量技术，行上气道CT三维重建，分析气道变化；头颅CT三维重建，分析突眼度、上下颌关系改变，及中面部在前颅底平面牵引前移的量，进而评估牵引成骨术在矫治中面部严重发育不良中的临床价值。结果11例患者经Le FortⅢ型颅面部截骨和牵引成骨术治疗后，气道梗阻情况得到解除，面部外形明显改善。术后上气道平均体积增加（9.13±6.94） cm3，气道梗阻较术前明显改善（P<0.01）；术前平均突眼度（21.23±3.3） mm，术后（11.4±3.5） mm，症状改善明显（P<0.01）；术后ANB矫正到平均（7.16±3.41）°，SNA矫正至平均（83.06±5.85）°，咬牙合关系改善（P<0.01）；术后中面部在前颅底平面平均前移（20.27±8.04） mm，术后平均随访5.4个月，CT示前移部分新生骨组织形成。结论 Le FortⅢ型截骨、牵引成骨手术治疗儿童中面部严重发育不良，可有效解除气道梗阻情况，改善面部外形。三维影像重建及测量技术是一种理想的评估方法。
목적：응용계산궤보조적삼유영상중건급측량기술，평고견인성골교치중면부발육불량기형적수술료효。방법자2005년지2010년，대11례엄중중면부발육불량환자，채용Le FortⅢ형로면부절골화견인성골술진행치료，술전、술후운용계산궤보조적삼유영상측량기술，행상기도CT삼유중건，분석기도변화；두로CT삼유중건，분석돌안도、상하합관계개변，급중면부재전로저평면견인전이적량，진이평고견인성골술재교치중면부엄중발육불량중적림상개치。결과11례환자경Le FortⅢ형로면부절골화견인성골술치료후，기도경조정황득도해제，면부외형명현개선。술후상기도평균체적증가（9.13±6.94） cm3，기도경조교술전명현개선（P<0.01）；술전평균돌안도（21.23±3.3） mm，술후（11.4±3.5） mm，증상개선명현（P<0.01）；술후ANB교정도평균（7.16±3.41）°，SNA교정지평균（83.06±5.85）°，교아합관계개선（P<0.01）；술후중면부재전로저평면평균전이（20.27±8.04） mm，술후평균수방5.4개월，CT시전이부분신생골조직형성。결론 Le FortⅢ형절골、견인성골수술치료인동중면부엄중발육불량，가유효해제기도경조정황，개선면부외형。삼유영상중건급측량기술시일충이상적평고방법。
Objective To evaluate the therapeutic effects of midface distraction osteogenesis in the treatment of midface hypoplasia by 3D reconstruction and measurement. Methods From 2005 to 2010, 11 cases with severe midface hypoplasia were treated with Le Fort Ⅲ osteotomy and distraction osteogenesis. The change of upper airway, eyeball position, occlusion and midface position were all measured by 3D reconstruction and measurement pre- and postoperatively. Results After Le Fort Ⅲ osteotomy and distraction osteogenesis, airway obstruction was effectively relieved and facial appearance was im-proved significantly. The upper airway volume was increased to (9.13±6.94) cm3 on average, and airway obstruction was effec-tively relieved comparing with preoperative values (P<0.01). The degree of exophthalmos was about (21.23±3.3) mm before operation, and (11.4±3.5) mm after operation. The proptosis was improved significantly (P<0.01). The ANB was (7.16±3.41) ° after operation, and SNA was (83.06 ±5.85) ° after operation. The occlusion was corrected. The midface was ante-displaced about (20.27±8.04) mm on average, and the new bone formation was observed by CT scanning after 5.4 months ’ follow-up. Conclusion Le Fort Ⅲ osteotomy and distraction osteogenesis in treating midface hypoplasia can improve the function of upper airway and the appearance of midface. 3D reconstructive and measurement is an ideal evaluation method.