三维CT在自体下颌骨外板修复面斜裂中的应用

Application of three-dimensional CT in the treatment of oblique facial clefts with mandibular outer cortex

目的 探讨三维CT在自体下颌骨外板行颅面部贴附植骨修复面斜裂中的应用,包括手术设计和术后效果评价.方法 回顾性分析2003年1月至2013年12月应用自体下颌骨外板行颅面部贴附植骨修复的22例面斜裂的病例资料.术前应用CT数据重建三维头颅,行三维测量和手术模拟;术中应用手术导板,切割下颌骨外板,移植修复骨缺损和骨凹陷部位,重建颅面骨支架的对称性;术后5—10 d和术后6个月至1年再次以CT进行三维测量和三维重建,以评价术后面部的对称性.结果 应用CT测量患侧凹陷眶骨骨缺损体积差,术后5—l0d比术前平均减少（64.6±14.4）％,眶下颧骨、上颌骨骨缺损体积差,平均减少（71.4±15.7）％.术后6个月至1年,下颌骨供骨区的体积恢复至所取骨块体积的（57.9±13.9）％,移植骨块被吸收体积为原移植骨块的（24.7±25.6）％.术前瞳孔中央的高度差为（3.76±1.27） mm,术后5～10d为（1.15±1.00） mm,术后6个月至1年为（1.35±1.13） mm,应用配对￡检验,术后5～10d瞳孔中央高度差比术前显著改善,差异有统计学意义（P=0.000）,术后6个月至1年与术后5～10d比较,差异也有统计学意义（P=0.003）,说明眼球位置有复发情况,可能与移植骨块吸收有关.结论 在三维CT辅助下,应用自体下颌骨外板行颅面部贴附植骨,可以更好地修复面斜裂,重建颅面骨支架的对称性,并且可对手术效果进行客观的评价.

Objective To investigate the application of three-dimensional CT （3D-CT） in the treatment of oblique facial clefts with mandibular outer cortex,including the surgical design and results assessment.Methods From Jan.2003 to Dec.2013,22 cases with oblique facial cleft,who underwent mandibular outer cortex onlay bone graft were retrospectively studied.3D images from CT data were reconstructed before operation for design.Then the mandibular outer cortex onlay bone transplant was performed to reconstruct the bone defect and cleft.3D CT was performed 5-10 days postoperatively and 6-12 months postoperatively to assess the facial symmetry.Results According to the results of CT measurement,the average volume of the orbital bone defects on the affected side decreased by （64.6 ± 14.4） % 5 to 10 days after operation.The average volume of the maxillary and zygomatic bone defects on the affected side decreased by（71.4 ± 15.7）% after surgery.After 6 to 12 months,the average recovery of the mandibular donor site was （57.9 ± 13.9）% of the removed mandibular outer cortex.The average absorption of grafted bones was （24.7 ± 25.6）%.The average height difference between the centre of pupils on both sides before surgery was（3.76 ± 1.27） mm,which decreased to（1.15 ± 1.00） mm 5 to 10 days after surgery（P=0.000）,and（1.35 ±1.13） mm 6 to 12 months after surgery（P=0.003）.The relapse may be caused by the absorption of the grafted bones.Conclusions 3D-CT can be used for preoperative design and postoperative assessment in the treatment of oblique facial cleft with mandibular outer cortex.