计算机辅助的设计牵引成骨治疗小颌畸形.docVIP

计算机辅助的设计牵引成骨治疗小颌畸形 　　[摘要]目的：探讨一种新的治疗小颌畸形的方法。方法：术前在计算机上进行手术模拟，设计截骨线的位置、牵引器的固定位置以及拟牵引的长度，并进行效果模拟，制作个性化手术导板。全麻下在导板指引下通过口外入路行内置式牵引器置入术。术后5～7d开始牵引，速度为1mm/d，牵引器保留3～8个月后行二期牵引器取出伴/不伴正颌手术。结果：随访6～24月，13例患者（年龄14.9±9.5岁）均无感染及其他并发症发生。下颌骨牵引成骨牵引距离为（23.8±4.6）mm。∠SNB术后较术前平均增加4.3°。咬合关系均由AngleⅡ错牙合趋近正常，面型改善满意。结论：计算机辅助设计牵引成骨治疗小颌畸形可以大大提高手术精度、减少手术创伤及并发症、实现手术效果可预测性。 　　[关键词]计算机辅助设计；牵引成骨术；小颌畸形 　　[中途分类号]R782[文献标识码]A [文章编号]1008-6455（2014）10-0811-04 　　 　　Computer-Aided design combined with distraction for the treztment of micrognathia 　　YIN Lin,TANG Xiao-jun,SHI Lei,LIU Wei,ZHANG Zhi-yong 　　(Department of Maxillofacial Surgery,Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100144,China) 　　 　　Abstract:ObjectiveTo explore a new technique for micrognathia deformity treatment. Methods Before the operation,a computer-assisted surgical simulation was prepared. According to the simulation data, an operative osteotomy guide plate was designed and three-dimensionally printed. With the help of the guide plate, the osteotomy line was precisely placed. An internal distractor was then placed through an extraoral incision created under general anesthesia. Distraction began after 5～7 days of latency at the rate of 1 mm/day. After a 3- to 8-month consolidation period, the distractor was removed with/without an orthognathic surgery to improve the facial contour and occlusion. Results The facial contour and occlusion were efficiently improved in all 13 patients (age, 14.9±9.5 years). No postoperative infection occurred. The distance of lengthening was (23.8±4.6)mm. The mean ∠SNB increased 4.3°. ConclusionApplication of CAD in distraction osteogenesis is a more safe, predictable and non-invasive alternative way for micrognathia treatment. 　　Key words:computer-assisted;distraction osteogenesis;micrognathia deformity 　　严重下颌骨发育不良，可造成面部外观严重畸形，还可同时伴随呼吸、咬合功能障碍。由于邻近软组织的牵拉限制(soft tissue envelope)，单纯传统正颌外科手术很难达到理想效果。自1992年McCarthy[1]首次将牵引成骨技术(Distraction