【作者】 李光辉；

【导师】 封兴华； 吴国锋；

【作者基本信息】 第四军医大学 ， 口腔临床医学， 2010， 硕士

【摘要】 先天性唇裂是人类最常见的出生缺陷之一,严重影响患儿的美观及其他诸如吞咽、吮吸、语言等功能,并可造成患儿的心理障碍。据统计我国目前每年新增单侧唇裂患儿约14000余例,数量十分庞大。目前修复单侧唇裂的手术方法较多,如旋转推进法、下三角瓣法、直线缝合法等等,但对于其优缺点众说纷纭,评价方法亦多种多样,缺乏权威性的说服力。因此,迫切需要客观、准确、可行性好的评价方法来判断术后治疗效果,指导临床实践。本研究利用可见光三维扫描仪对单侧唇裂患儿进行面部扫描,获得患儿术前及术后面部形态数据,然后将其导入逆向工程软件Geomagic Studio 10.0中进行重建并进行数据测量,以此为基础建立一种评价手术效果的方法,并尝试以此方法评价临床最常用的手术方法旋转推进法(Millard法)的修复效果。研究结果如下:1.利用三维扫描仪对一例单侧唇裂(Ⅲ度)患儿进行面部扫描,获得患儿术前及术后面部形态数据,将其导入逆向工程软件Geomagic Studio 10.0中进行重建并进行数据测量。结果:该方法能快速、准确地完成患儿面部形态的重建,并可以在软件中完成面部标志点的标定、既定标志点间距离的测量,证明可以以此为基础建立一种新型评价单侧唇裂修复术后效果的方法。2.将利用可见光三维扫描仪结合逆向工程软件所得到患儿面部数据,对比应用手工方法测量全麻成功后的患儿面部数据。结果表明:二者测量值之间无统计学差异(P>0.10),证明采用本方法获得的数据精确度是可靠的,能满足评价手术效果的需要。3.利用本方法评价Millard法修复单侧唇裂的手术效果,发现:Millard法修复单侧唇裂,患儿术后鼻底封闭、鼻小柱偏斜畸形矫治、唇弓形态均恢复较好;但患侧唇高均有不同程度地下降不足,健、患侧鼻小柱高度的不对称仍较明显。这些结论与多年的临床经验相符,可佐证本方法的可行性。通过研究发现,应用三维扫描仪结合逆向工程软件能快速、准确地完成患儿面部形态的重建,并可以在软件中完成面部标志点的标定、既定标志点间距离的测量,并以此为基础建立一种新型评价单侧唇裂修复术后效果的方法,且该方法客观、准确、可操作性好,值得推广。更多还原

【Abstract】 Congenital cleft lip is one of the most common human birth defects, one seriously affect the aesthetics as well as other functions, such as swallowing, sucking, language, and can result in children with psychological barrier. According to statistics, China’s current annual increase of about 14,000 more than in children with unilateral cleft lip cases whose number is large. Unilateral cleft lip repair surgery now means more, such as the rotation-advancement repair, Tennison- Randall triangular flap repair, a straight-line repair, etc. However, the advantages and disadvantages of different methods have been varied. The urgent need for an objective, feasible and good methods for evaluation is demanded which assess the effect of postoperative treatment and guide clinical practice.In this study, three-dimensional scanner for facial scans in children with unilateral cleft lip, access to children pre-and postoperative facial shape data, and then import it into reverse engineering software Geomagic Studio 10.0 in the reconstruction and data measurement, as a basis for to establish a method of evaluation of results of operations, and try this method of evaluation of the most common surgical methods of rotation-advancement repair (Millard’s method) of the repairing effect. The results are as follows:1. Using three-dimensional scanner of one cases of unilateral cleft lip (Ⅲdegree) in children with facial scans obtained before and after surgery in children with facial morphology data, import it into reverse engineering software Geomagic Studio 10.0 in the reconstruction and measured data. Results: This method can quickly and accurately complete the reconstruction in children with facial morphology, and can be completed in the software calibration of facial landmarks, the distance between the established landmarks measurements, proved to be as a basis for the establishment of a new evaluation of unilateral effect of method of cleft lip repair surgery.2. Stresses the use of three-dimensional scanner with reverse engineering software to children with facial data obtained, compared to manual application of methods to measure anesthesia in children after the success of facial data. The results showed that: the two was no significant difference between the measured values (P> 0.10), thus proving the accuracy of the data obtained is reliable and can meet the need for evaluation of results of operations.3. Use this method of evaluation of Millard’s method of unilateral cleft lip repair surgery and found that: Millard’s method is useful for repairing unilateral cleft lip in recovering nasal floor, the Cupid’bow and in remedying the deviation of columella except for a little shortage of the lip height and columella length of the operated side, which is corresponded with many years of clinical experience. The conclusion supports the feasibility of this new method for evaluating the outcome of clinical practice.Through research we found that three-dimensional scanner with reverse engineering software can quickly and accurately complete the reconstruction in children with facial morphology, and can be completed in the software calibration of facial landmarks, the established measurement of the distance between landmarks, and as a basis for the establishment of a new evaluation of unilateral cleft lip repair surgery results-based approach, and the method is objective, accurate, feasible, worthy of promotion.更多还原