基于三维测量评估下颌角弧形截骨术后效果稳定性的研究

Evaluation of stability after mandibular angle osteotomy based onthree-dimensional measurement

目的:探究下颌角弧形截骨术后效果以及长期稳定性,分析下颌角肥大复发的影响因素。方法:选取2018年1月1日至2020年12月31日于中国医学科学院整形外科医院颅颌面二中心行“下颌角弧形截骨,下颌骨外板打磨手术”的患者,收集其术前、术后3 d及术后12个月拍摄的CT资料,采用Mimics软件进行三维重建测量分析,对比3个时间点下颌角区骨量,并分析术后骨量增生与咬肌、翼内肌厚度的关系。结果:共有19例诊断为双侧下颌角肥大的患者纳入研究,患者术前单侧下颌角区骨量为(11.93±1.77)cm^(3),术后3 d单侧下颌角区骨量为(7.72±1.60)cm^(3),术后12个月随访单侧下颌角区骨量为(8.73±1.69)cm^(3)。对3组数据进行两两配对t检验得出,术后3 d相较术前下颌角区骨量明显减少(P<0.001),术后12个月相比术后3 d下颌角区骨质出现明显增生(P<0.001),但术后12个月相比术前下颌角区骨质仍显著减少(P<0.001)。此外,对下颌角区骨质增生量与该处附着咬肌、翼内肌厚度采用Pearson相关性分析显示,骨质增生量与咬肌厚度呈显著正相关(r=0.560,P<0.01),与翼内肌厚度无明显关联(P>0.05)。结论:下颌角弧形截骨术可显著减小患者下颌角区骨体积,但术后会出现一定程度的骨质增生,这种骨质增生与该处附着咬肌厚度相关。

Objective:To explore the postoperative effect and long-term stability of mandibular angle arc osteotomy,and to analyze the influencing factors of recurrence of prominent mandibular angle.Methods:From 2018.1.1 to 2020.12.31,patients with prominent mandibular angle received mandibular angle osteotomy,computed tomography(CT)data was collected on the preoperative day and 3 days postoperative and 12 months after operation.Mimics software was used to do the three-dimensional reconstruction and measurement.Data was compared of the three time points angle bone volume,and the relations between postoperative bone hyperplasia and thickness of masseter muscle was analyzed.Results:A total of 19 patients diagnosed with bilateral prominent mandibular angle were included in this study.Data analysis showed that the preoperative bone volume in the unilateral mandibular angle was(11.93±0.27)cm^(3),it was(7.72±0.26)cm^(3),3 days after the operation and was(8.73±0.27)cm^(3) the follow-up 12 months after the operation.Paired t-test was performed on the three groups of data,and it was found that the bone volume in the angle area was significantly reduced 3 days after surgery compared with that before surgery(P<0.001),12 months postoperatively compared with 3 days postoperatively,there was significant osteogeny in the mandibular angle(P<0.001),but there was still a significant reduction of bone volume in the angle area 12 months after surgery compared with preoperation(P<0.001).In addition,the amount of osteogenesis in the mandibular angle and the thickness of the attached masseter muscle were obtained by Pearson correlation analysis,and there was a significant positive correlation between the amount of bone hyperplasia and the thickness of masseter muscle(P<0.01).Conclusion:Mandibular angle osteotomy could significantly reduce the bone volume in patients with prominent mandibular angle,but a certain degree of bone hyperplasia may occur after surgery,which is related to the thickness of the masseter muscle attached in this area.