三维设计打印技术在正颌术后不对称畸形修整中的应用

The application of three-dimensional design and printing in the secondary surgery of asymmetric deformity correction after orthognathic surgery

目的探讨三维设计打印技术在正颌术后再次手术修整中的应用效果。方法回顾性分析2016年1月至2020年8月于深圳大学附属深圳大学总医院口腔科及深圳大学附属深圳市口腔医院口腔颌面外科收治并复查的正颌术后面部外形不对称患者资料。使用三维设计打印技术,术前数字化设计手术方案、打印截骨导板,术中使用数字化导板精准施术。分别于术前、术后半年至1年由患者、主刀医生和第三方进行满意度评价。于术前及术后6个月至1年进行数字化评价,行螺旋CT扫描统计测量颏中点到正中矢状面距离、双侧下颌骨体部最突点到正中矢状面距离,判断术后患者不对称畸形是否改善及与术前设计是否一致。采用SPSS 17.0统计软件处理数据,计量资料以±s表示,患者、主刀医师及第三方术前与术后满意度、术前与术后测量数据及术前模拟与术后实际数据比较采用配对t检验,主刀医生、第三方与患者满意度术前及术后比较时,采用方差分析及Dunnett-t检验。结果研究共纳入患者16例,男3例,女13例,年龄18~35岁。其中9例颏部偏斜患者采用颏成形术,4例双侧下颌骨体部不对称患者采用单侧下颌骨体外板切除术,3例患者同时存在颏部及下颌骨体部不对称,同期采用两种术式。16例均按照术前数字化设计方案顺利完成手术。术后随访6个月至1年。12例颏成形术患者,颏点到正中矢状面距离由术前(4.99±0.83)mm缩减至术后(1.63±0.80)mm,差异具有统计学意义(t=9.09,P<0.001);术后测量值与术前设计值[(1.50±0.43)mm]差异无统计学意义(t=-0.83,P=0.423)。7例单侧下颌骨体外板切除术患者,双侧下颌骨体部最突点到正中矢状面距离差值,由术前(7.26±1.20)mm缩减至术后(2.44±0.56)mm,差异具有统计学意义(t=10.26,P<0.001);术后测量值与术前设计值[(2.39±0.16)mm]差异无统计学意义(t=-0.29,P=0.779)。术前患者、主刀医生、第三方满意度分别为(65.94±8.21)分、(79.69±5.91)分、(79.38±7.50)分,术后患者、主刀医生、第三方满意度分别为(90.00±5.48)分、(90.63±2.50)分、(90.00±4.08)分。患者、主刀医师、第三方术后满意度较术前提高,差异均有统计学意义(t=-9.15、P<0.001,t=-7.50、P<0.001,t=-6.04、P<0.001)。术前主刀医生、第三方与患者满意度比较,差异有统计学意义(F=18.66,P=<0.001),主刀医生与患者(P<0.001)及第三方与患者(P<0.001)比较,差异均有统计学意义;术后主刀医生、第三方与患者满意度比较,差异无统计学意义(F=0.12,P=0.889)。结论三维设计打印技术可进行全面三维分析、精准模拟手术、图像化预测结果,并利用三维打印导板精准施术,提高术后满意度,在正颌术后不对称畸形修整的应用中具有明显优越性。

Objective To explore the effect of three-dimensional(3D)design and printing in the reoperation of asymmetric deformity after orthognathic surgery.Methods Patients of facial asymmetry after orthognathic surgery were included in the Department of Stomatology,Shenzhen University General Hospital and Department of Oral&Maxillofacial Surgery,Shenzhen Stomatology Hospital Affiliated to Shenzhen University from January 2016 to August 2020.Surgical plans and guide plates(positioning guide plate,bone cutting guide plate,reset guide plate)were made by 3D design and printing.During the operations,guide plates were used to guide osteotomy.The facial shape satisfaction of clinicians/patients/third-party were recorded and analyzed at preoperation and 6-12 months postoperation.These patients’CT scan data was imported to the digital surgery software.Then the distance of chin-midpoint to mid-sagittal plane and the difference of bilateral protuberant point of mandible body to mid-sagittal plane were measured at preoperation and 6-12 months postoperation to determine whether the asymmetry were corrected and postoperative distance were the same as the preoperative design.Data analysis was conducted using SPSS 17.0 statistical software,and measurement data were expressed as Mean±SD.The preoperative and postoperative satisfaction of patients/clinicians/third-party,digital data of preoperation/postoperation and digital data of design-operations/postoperation were analyzed by paired t-test.Analysis of variance and dunnett-t test were used to compare the satisfaction of the surgeon,the third party and patients before and after operation.Results There were 16 cases of facial asymmetry after orthognathic surgery,including 3 males and 13 females,aged from 18 to 35 years.In 9 cases,genioplasty were used to correct chin deviation.In the other 4 cases,unilateral buccal cortical bone resection were used to correct mandibular body deviation.In the last 3 cases,genioplasty and unilateral buccal cortical bone resection were both applied.All 16 patients successfully received the operation according to the preoperative digital designed plate.Postoperative follow-up ranged 6 months to 1 year.In the 12 cases of genioplasty,the distance of chin-midpoint to mid-sagittal plane reduced from(4.99±0.83)mm preoperatively to(1.63±0.80)mm postoperatively and the difference significant(t=9.09,P<0.001).There was no significant difference between the distance of preoperative design[(1.50±0.43)mm]and the postoperative one(t=-0.83,P=0.423).In the 7 cases of unilateral buccal cortical bone resection,the difference of bilateral protuberant point of mandible body to mid-sagitta plane reduced from(7.26±1.20)mm preoperatively to(2.44±0.56)mm postoperatively and the difference was statistically significant(t=10.26,P<0.001).There was no significant difference was observed between the distance of preoperative design[(2.39±0.16)mm]and the postoperative one(t=-0.29,P=0.779).The preoperative satisfaction of patients,clinicians and third-party were 65.94±8.21,79.69±5.91,79.38±7.50.The postoperative satisfaction of patients,clinicians and third-party were 90.00±5.48,90.63±2.50,90.00±4.08.The postoperative satisfaction of patients,chief surgeon and third party was higher than that preoperative satisfaction and the difference was statistically significant(t=-9.15,P<0.001;t=-7.50,P<0.001;t=-6.04,P<0.001).The difference of preoperation satisfaction was statistically significant(F=18.66,P<0.001).The difference of satisfaction of the clinicians and the patients was statistically significant(P<0.001).The difference of satisfaction of the third-party and the patients was statistically significant(P<0.001).The difference of postoperation satisfaction was not statistically significant(F=0.12,P=0.889).Conclusions 3D design and printing can 3D analyze comprehensively,simulate surgery accurately,visualize proposed result and guide 3D printing digital guiding plate to perform surgery accurately.In addition,it can improve postoperative satisfaction.So 3D design and printing had obvious advantages in the secondary surgery of asymmetric deformity correction after orthognathic surgery.