数字化与超声骨刀结合在正颌外科中的临床应用和疗效评估

Clinical application and critical evaluation of digital combined with piezoelectric osteotomy in orthognathic surgery

目的在数字化外科的前提下,评价超生骨刀在正颌外科手术中的临床应用效果。方法本研究为回顾性研究。超声骨刀组选取自2017年6月至2018年4月就诊的牙畸形患者43例,患者术前均经过数字化诊断设计,应用超生骨刀完成手术。所有患者行双侧下颌骨矢状骨劈开术(BSSRO),2例(5%)行颏成形术,11例(26%)行双颌手术(上颌骨Lefort Ⅰ型截骨+BSSRO)。传统组选择自2016年6月至2017年4月就诊的牙畸形患者45例,所有患者均行BSSRO术,4例(8%)行颏成形术,17例(38%)行双颌手术;术前患者均经过数字化诊断设计,应用传统往复锯及骨凿完成手术。评估只行BSSRO术患者的手术时间及术后负压引流量;双颌手术患者术中出血量;观察所有患者术中神经和软组织损伤及术后3个月的神经损伤情况。结果超生骨刀组的失血量为(190.9±45.8)ml明显低于传统组的失血量(242.6.5±70.4)ml,其差异具有统计学意义(P<0.05);超声刀组的术中神经及软组织损伤和术后3个月神经损伤情况均低于传统组(P<0.05);其余评估指标均无统计学意义。结论数字化外科可以对畸形的严重程度做出较准确的诊断及设计相对应的手术方案,提高手术的可预见性,超声骨刀具有不损伤软组织的特点,在正颌外科中将两者结合可以到达更加精确和减少创伤的目的。

Objective Based on digital diagnosis design,the clinical application and the critical evaluation of piezoelectric osteotomy in orthognathic surgery were studied.Methods In a retrospective study,forty-three patients with dental and maxillary deformity were selected from June 2017 to April 2018.All patients accepted digital diagnostic design before operation and underwent surgery with piezoelectric osteotomy： 43 cases（100%） of bilateral sagittal split ramus osteotomy（BSSRO）,2 cases（5%） of genioplasty,and 11 cases（26%） of bimaxillary osteotomy（Lefort I osteotomy ＋ SSRO）.From June 2016 to April 2017,forty-five patients were selected as the control group： in 45 cases（100%） bilateral sagittal split ramus osteotomy（BSSRO） was performed,in 4 cases（8%） genioplasty was performed,in 17 cases（38%） bimaxillary osteotomy（Lefort Ⅰ osteotomy ＋ SSRO） was performed.All patients underwent digital diagnostic design before the operation and the operation was performed with traditional reciprocating saw and chisel.The time of operation and postoperative negative pressure drainage in patients who underwent only bilateral sagittal split mandibular surgery（BSSRO）,the volume of intraoperative bleeding in patients undergoing bimaxillary surgery,the ratio of intraoperative nerve and soft tissue macroscopic injuries,intraoperative root injuries,and neurologic disorders were evaluated 3 months after operation in all cases.Results Based on digital diagnosis design,the amount of blood loss in bimaxillary osteotomy was（190.9±45.8） ml,which was significantly lower than that in the control group of（242.6.5±70.4） ml,and the difference was statistically significant（P0.05）.Among the patients who received piezoelectric osteotomies,there were no cases of intraoperative nerve and soft tissue injury.However,there were 8 cases of injury in the traditional group（P0.05）.About 19% patients in the piezoelectric osteotomy group had neurogenesis.This was less than the 32% of occurrences in the traditional group（P0.05）.There was no significant difference in the other results.Conclusion Digital surgery can make more accurate diagnosis of the severity of malformation,improving the corresponding surgical plan,and the predictability of surgical results.Piezoelectric osteotomy results in no soft tissue damage.Combining the two methods in orthognathic surgery can lead to greater accuracy and less trauma.