数字化技术在下颌角截骨术中的应用

Application of digital planning in goniolpasty

目的运用计算机辅助设计下颌角肥大患者的美学下颌角点和截骨线，探讨三维数字化技术在下颌角截骨术中的临床应用。方法2016年4月至2017年4月，采用数字化技术对14例下颌角肥大的女性患者行术前分析、设计和手术模拟，制作截骨导板，完成下颌角截骨术。分别测量术前、手术模拟和术后患者两侧下颌角度数、下颌升支高度（Co-Go）和下颌骨体部长度（Go-Me），采用配对t检验对模拟手术和截骨术后数据进行分析。 结果14例患者手术顺利，效果满意，左侧下颌角由术前的113.86°±4.11°改善为124.52°±1.26°，右侧由114.30°±4.01°改善为124.29°±1.24°。术后两侧Go-Me/Co-Go均为2.011，与术前设计非常接近。模拟手术和术后测量数据在下颌角度数和Go-Me/Co-Go之间差异无统计学意义（P〉0.05），二者之间差异的平均值在左侧分别为1.00°±0.68°和0.058±0.038，右侧0.85°±0.63°和0.072±0.053。 结论计算机辅助的下颌骨截骨术可以显著地提高手术的精准度，降低手术风险，提高患者满意度。

ObjectiveTo design the aesthetic new gonion and osteotomy line for patients with prominent mandibular angle patients using computer-aided techniques, and to investigate the application of three-dimensional digital planning in gonioplasty.MethodsFrom April 2016 to April 2017, 14 female patients with prominent mandibular angle underwent preoperative surgical design and surgical simulation using digital technology. Gonioplasty was performed under the guide of surgical templates, preoperative, surgical simulation and postoperative data were measured including bilateral mandibular angles, the height of ramus（Co-Go） and the length of mandibular body（Go-Me）. Paired t test was used to compare the differences between surgical simulation and postoperative measurements.ResultsGonioplasty was performed in 14 patients successfully, and all were satisfied with their facial outcomes. The mandibular angle was improved from 113.86°±4.11° to 124.52°±1.26° on the left side, and 114.30°±4.01° to 124.29°±1.24° on the right side respectively. The average ratio of Go-Me/Co-Go was 2.011 on both sides after operation, which was very close to surgical planning. No significant differences were found between surgical planning and postoperative measurements with respect to mandibular angle or the ratio of Go-Me/Co-Go on both sides（P〉0.05）. The deviations between them were 1.00°±0.68° and 0.058±0.038 on the left side, and 0.85°±0.63° and 0.072±0.053 on the right side respectively.Conclusions Computer-assisted gonioplasty could improve the efficiency and accuracy of surgery, reduce the risk of surgical complications, and attain higher patients′ satisfaction.