改良数字化再定位导板和咬合导板辅助Le Fort Ⅰ型截骨上颌骨精准定位

Clinical application of improved digital guide and occlusal guide in the precise localization for maxillary Le Fort Ⅰ osteotomy

背景:上颌骨Le FortⅠ型截骨是矫正上颌骨畸形及与颅骨位置关系异常最常见的手术方法,以往采用传统模型外科进行手术设计及手工制作咬合板的方法,人为操作误差大,难以精准地实施手术设计方案。近年来3D打印数字化定位导板在正颌外科中的应用显著提高了手术操作的精准度。目的:探讨改良数字化定位导板在上颌骨Le FortⅠ型截骨中的应用效果。方法:选择20例因上颌骨发育异常行上颌骨LeFortⅠ型截骨的患者,术前行薄层颅颌面CT扫描,将CT数据导入Mimics 20.0软件建立数字化模型,并进行虚拟手术设计。同时设计打印出改良数字化上颌骨截骨导板、上颌骨再定位导板和咬合定位导板,术中联合应用3种导板行上颌骨的截骨及再定位。术后1周复查颅颌面CT并进行设计方案的术后验证。结果与结论:①上颌骨模拟位置和术后实际位置距离偏差中位数的绝对值小于1 mm,牙合平面角度偏差中位数的绝对值小于1°;②图像融合偏差分析中,均方根值=(0.789±0.275)mm,其均数小于1 mm;③提示应用改良数字化上颌骨截骨导板、上颌骨再定位导板及咬合定位导板能够安全、便捷、精准地完成上颌骨Le FortⅠ截骨。

BACKGROUND: Maxillary Le Fort I osteotomy is the most common method to correct the upper jaw deformity and abnormal position. Traditional modelsurgery is difficult to accurately implement the operation plan in the operation. In recent years, 3D-printed digital guides have been widely used in orthognathicsurgery.OBJECTIVE: To discuss the application efficacy of improved digital guide in the precise localization for maxillary Le Fort I osteotomy.METHODS: Twenty patients with maxillary hypoplasia who underwent Le Fort I osteotomy were enrolled. All the patients underwent preoperative cranialmaxillofacialCT scanning, and the CT data were imported into Mimics 20.0 software to establish a digital model, and the surgical virtual design was carriedout. At the same time, the digital osteotomy guide, repositioning guide and occlusal guide were designed and printed, and these three guides were combinedto perform the maxillary osteotomy and repositioning. One week after the operation, the cranial-maxillofacial CT was reviewed and the design scheme wasverified.RESULTS AND CONCLUSION: The absolute value of the median distance deviation between the simulated maxillary position and the actual postoperativeposition was less than 1 mm. The absolute value of the median angle deviation in the occlusal plane was less than 1°. In the analysis of image fusion deviation,root mean square value was (0.789±0.275) mm, whose mean was less than 1 mm. These findings indicate that the combined application of digital guides inmaxillary Le Fort I osteotomy is safe, convenient and accurate.