【作者】 董岩；

【导师】 赵铱民；

【作者基本信息】 第四军医大学 ， 口腔临床医学， 2010， 博士

【摘要】 外鼻位于颜面部中央,是评价面部美学特征的重要对象,因此外鼻缺损后进行修复时要求达到很高的仿真程度。传统的鼻赝复体制作采用手工方式,医师工作强度大,制作效率低,仿真程度受到医师美学基础和雕刻技术的限制,不易于获得满意的临床效果。近年来,CAD/CAM技术的应用为颜面赝复学的发展提供了一条新的途径。利用CAD/CAM技术进行赝复体的设计与制作,可以降低医师工作强度,提高制作效率,并显著改善仿真效果,因此具有广阔的前景,成为颜面赝复学的主要发展方向之一。但是,要将该技术在颜面赝复领域推广应用,还有许多问题待解决。特别对于外鼻缺损,由于外鼻既是颜面部最重要的特征器官,又是单一器官,如缺损过大则无正常外形做参考,在进行计算机辅助设计时,面临缺少原始形态数据的问题,难以实现仿真重建。因此本研究拟建立外鼻三维形态数据库,以满足计算机辅助设计鼻赝复体的需要,为该技术的推广应用奠定基础。大量外鼻三维形态数据的获取是建立数据库的首要环节。本研究采用筛选现有CT数据进行三维重建为主,以3DSS-Ⅱ型结构光三维扫描系统为补充的方式进行外鼻三维形态数据的获取。利用CT数据重建颅面部软组织三维形态从而完成CAD/CAM颜面缺损修复的可靠性和准确性已被研究所证实,但是利用3DSS-Ⅱ型结构光三维扫描系统获取颜面部数据的准确性和可靠性尚未见研究报道,因此本研究首先对这方面进行探讨。确定数据获取方法后,本研究进行了三维数据的获取工作。数据库的建立除拥有大量数据作为基础以外,还需要合理的系统对这些数据进行管理。因此,本研究应用Microsoft Visual C++,结合Microsoft Office Access和OpenGL进行了数据库管理软件的开发。数据库的建立完成后,本研究对数据库的应用进行了探讨。首先对数据库在计算机辅助设计鼻缺损修复方面的应用进行了研究。此外,为充分开发数据库的应用价值,对其在外鼻测量领域的应用进行了研究。所取得的主要研究结果如下:1.应用3DSS-Ⅱ型结构光三维扫描系统进行颜面部软组织测量能够较好的反映出颜面部软组织真实形态,其可靠性与手工测量相当,因此3DSS-Ⅱ为颜面部软组织形态数据的获取提供一种新途径,也可以作为外鼻三维形态数据获取的一种有效手段。2.通过筛选现有CT数据进行三维重建,获得外鼻三维形态数据1000例,利用3DSS-Ⅱ扫描系统扫描志愿者,获取外鼻三维形态数据200例,包含了汉族人主要类型的外鼻形态。3.成功开发了数据库管理软件。该软件结合六种外鼻分型方法,利用录入、查询、浏览等功能,实现了外鼻三维形态数据的合理管理。六种外鼻分型方法中既包括按照外鼻总体形态特征的分型方法,又包括五种按局部特征(鼻背形态、鼻尖形态、鼻基底形态、鼻孔形状、鼻翼形态)的分型方法,涵盖了各类外鼻形态特征。综合这六种外鼻分型方法,使数据库可以对任意类型的外鼻三维数据进行归类管理。软件的录入功能利用对话框实现了人机交互,对于收集到的每一个外鼻三维数据,按照上述六种外鼻分型方法,分别赋予其对应分型的特征信息,并将三维数据连同其特征信息一起存储于数据库的特定位置中。此外,拥有录入功能的数据库是开放型的数据库,通过积累,可以不断扩充其数据规模。软件的查询功能可实现多条件查询,即可以按照上述六种分型方法中的一种或多种进行查找,便于快速选择实际需要的外鼻三维数据。软件的浏览功能实现了三维数据的可视化,不需借助于其他专业三维软件,便可对三维数据进行各角度、各部位的浏览,使数据录入和查询的效率和效果得到保证。4.通过对数据库在计算机辅助设计鼻缺损修复中的应用进行研究,探讨了数据库在计算机辅助设计鼻赝复体过程中的应用方式,得出结论认为该数据库解决了计算机设计鼻赝复体过程中缺少原始形态数据的问题,使鼻缺损仿真修复的过程简单化。本研究还提出了一种新的构建赝复体三维实体模型的方法,解决了CAD赝复体模型与患者缺损区的对位问题,实现了二者的良好匹配,并且可以保证模型的立体形态与赝复体外形一致,大大降低了赝复体制作后期处理的难度。5.提出一种三维人体测量学方法,并应用该方法利用数据库资料对汉族人外鼻进行了测量学研究,建立了汉族人标准外鼻三维立体模型。该模型与传统二维测量结果相比,包含更多的信息量,可立体直观的表现出汉族成年人外鼻形态特征,便于研究者和医生对于外鼻形态的理解和掌握,对于汉族人鼻缺损修复重建,以及鼻畸形的术前预测与术后评估等具有重要的指导意义。更多还原

【Abstract】 The nose is located in the central part of the face, and its appearance contributes enormously to facial aesthetics. As a result, the reconstruction of nasal defects requires high quality of morphological simulation. Wax models of traditional nasal prostheses were carved by hand, which was low quality and low efficiency. Recent years, CAD/CAM technology has been an alternative to traditional methods for the reconstruction of facial defects. This technology has various advantages and will be routinely used in clinical. In the CAD procedure of restoration of a patient with the defect of the bilateral organs, it is easy to cover the defect area by mirroring the healthy side. However, if the patient has the defect of nose, it is hard to find a proper nose for design of the prosthesis. The purpose of this study was to establish a database of 3D models of nasal shapes, which was aimed to meet the need of CAD nasal prosthesis.As to the contents, this study contained two main parts. The first was the establishment of database, and the second was the applications of the database. The follows were the main contents and the results of this study.1. Data Acquisition was the first procedure of the establishment of database. This study intended to use the computed tomography and 3DSS-Ⅱto acquire nasal data. As to the reliability and accuracy of facial reconstruction, there have been some reports on the CT, but the related researches on 3DSS-Ⅱwere insufficient. So reliability and accuracy of 3DSS-Ⅱin reconstruction of facial images were tested at first. The results show that the reliability of 3DSS-Ⅱwas no less than the direct measurement, and the accuracy of 3DSS-Ⅱhas no significant difference with direct measurement. In conclusion, 3DSS-Ⅱcould be used to acquire nasal data for the database.2. The following procedure was the acquisition of 3D nasal morphological data. As a result, 1000 nasal models were collected by 3D reconstruction of the existed CT data, and 200 nasal models were collected by3DSS-Ⅱ.3. There were so many nasal models, that we might be overwhelmed with these data. Therefore, there was an urgent need to develop database software to organize these models. In this study, the software were based on Microsoft Office Access, and were written by Microsoft Visual C++. OpenGL were used to realize the visualization of three-dimensional data. In this procedure, nasal shape classification must be mentioned. Until now, there have been many different classifications, but no unified classification, and no one classification can include all nasal shapes. On this condition, multiple classifications were integrated to develop our database. In this way, the database could contain most of the nasal shapes. With the help of the software, nasal models could be imported into the database accompanied with their morphological features, and people could easily find the proper models for their certain needs. 4. When all the nasal models were imported into the database, the establishment of database was finished. As follows, the application of the database was conducted. One application is the clinical use for restoration of the patient with nasal defect. Searching for proper nasal model is an indispensable step of the restoration of nasal defect with CAD/CAM. In this study, the procedure of selecting a proper nasal model for a patient with nasal defect was introduced, and the result showed that the usage of the database was an efficient solution to the problem of lack of references in the process of CAD restoration of nasal defect.5. To make full use of the database, this study applied it to nasal anthropometry. In this database, many three dimensional nasal models were sorted in particular classifications. Therefore, it was possible to conducted 3D anthropometry without recruitment of volunteers. In this study, a novel method for nasal anthropometry was introduced, and 3D standard models representing nasal shapes were created. Compared with traditional 2D parameters, these visualized 3D standard models facilitated the comprehension of the nasal morphology. It would provide useful guidance for the researchers who needed the information of nasal shape.更多还原