CAJ | 학술논문

目的探索术前三维头模设计及个体化模板引导在下颌骨牵引成骨术中的应用,并且评估手术的治疗效果.方法选择原发或继发小颌畸形患者10例,均伴有中度或者重度的阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS).根据三维螺旋CT的数据制作三维头模,在三维头模上模拟手术截骨以及牵引器的安放,制作个体化模板.术中应用个体化模板指导截骨线的位置以及牵引器的安放.术后5～7 d的间歇期后,开始以每天1 mm的速度行骨牵引至牵引结束.术后3～6个月二次手术去除牵引器.结果 10例患者顺利完成下颌骨牵引成骨治疗,第一次手术平均手术时间为(1.6±1.3)h.10例患者的20侧下颌骨平均牵引长度为(23.6±7.5) mm.术前睡眠呼吸暂停低通气指数(apnea and hypopnea index,AHI)为(37.1±13.7)次/h,睡眠时最低血氧饱和度(lowest oxygen desaturation,LSAT)为75.2％±18.4％;术后AHI为(2.7±4.8)次/h,LSAT为92.1％±5.3％.所有患者的牵引成骨区成骨良好,均未出现成骨不良、下牙槽神经损伤及牵引故障等严重并发症.结论术前三维头模设计可以很好的模拟牵引成骨术中的截骨位置及牵引器的安放,避免损伤重要解剖结构;应用个体化模板引导可以提高下颌骨牵引成骨术截骨及牵引器安放的精确性,缩短手术时间,降低手术难度及风险.
목적 탐색술전삼유두모설계급개체화모판인도재하합골견인성골술중적응용,병차평고수술적치료효과.방법 선택원발혹계발소합기형환자10례,균반유중도혹자중도적조새성수면호흡잠정저통기종합정(obstructive sleep apnea-hypopnea syndrome,OSAHS).근거삼유라선CT적수거제작삼유두모,재삼유두모상모의수술절골이급견인기적안방,제작개체화모판.술중응용개체화모판지도절골선적위치이급견인기적안방.술후5～7 d적간헐기후,개시이매천1 mm적속도행골견인지견인결속.술후3～6개월이차수술거제견인기.결과 10례환자순리완성하합골견인성골치료,제일차수술평균수술시간위(1.6±1.3)h.10례환자적20측하합골평균견인장도위(23.6±7.5) mm.술전수면호흡잠정저통기지수(apnea and hypopnea index,AHI)위(37.1±13.7)차/h,수면시최저혈양포화도(lowest oxygen desaturation,LSAT)위75.2％±18.4％;술후AHI위(2.7±4.8)차/h,LSAT위92.1％±5.3％.소유환자적견인성골구성골량호,균미출현성골불량、하아조신경손상급견인고장등엄중병발증.결론 술전삼유두모설계가이흔호적모의견인성골술중적절골위치급견인기적안방,피면손상중요해부결구;응용개체화모판인도가이제고하합골견인성골술절골급견인기안방적정학성,축단수술시간,강저수술난도급풍험.
Objective To investigate the applications of preoperative 3D head modeling and individualized template guiding in mandibular distraction and to evaluate the effect postsurgery.Methods 10 patients with mandibular micrognathia,who developed moderate to severe OSAHS were selected.All patients underwent mandibular distraction.3D head models were printed based on spiral CT data.Preoperative simulations of osteotomy and distractor placement were done with the 3D head models,and accordingly,individualized templates were fabricated.During surgery,the templates guided the position of osteotomy line and placement of distractors.The distraction begun 5 ～ 7 days after operation at a frequency of 1 mm/day.After distraction,the distractors were maintained for 3～6 months till removed.Results All 10 cases were treated successfully.Average operation time was (1.6 ± 1.3) h.The mean distraction distance was (23.6 ± 7.5) mm.The preoperative polysomnography showed an apnea-hypopnea index of (37.1 ± 13.7) per hour and a lowest oxygen saturation of (75.2 ± 18.4)％.Postoperative polysomnography showed improvement that apnea-hypopnea index changed to (2.7 ± 4.8) per hour and lowest oxygen saturation to (92.1 ± 5.3)％.No complication occurred during treatment.Conclusions The preoperative simulations show excellent guides during surgery,which will improve surgical precision,shorten the operation time,avoid injury of important anatomical structures,reduce operation difficulties and minimize possible risks.