【作者】 安纲；

【导师】 归来；

【作者基本信息】 北京协和医学院 ， 外科学， 2014， 博士

【摘要】 研究目的1、探索一种简便易行的方法进行颧上颌骨纤维异常增殖症的术前设计和术中指导,提供客观的测量指标,提高手术的精确性和安全性。2、为额眶部骨纤维异常增殖症的手术治疗进行预设计,提供客观的测量指标,提高手术的精确性和安全性。3、以数字化技术对颅眶部骨纤维异常增殖症术前与术后的眶容积和突眼程度进行测量,从而探讨两者之间的关系,为临床预测突眼度改善的效果提供预测方法。4、采用数字化方法对颅面部骨纤病灶进行定量运算,提供定量指标以供比较病灶的生长速度,从而为临床随访诊断提供可靠的数据。方法1、采用镜像法和数字减影法,计算病灶范围,为术中眶底病灶切除和颧上颌部病灶切除的操作提供测量数据；重建眶下神经血管束,根据病灶区范围预设计分段截骨方案；虚拟设计截骨效果,为手术方案提供参考。2、虚拟设计截骨后的颅骨缺损效果图,打印三维头模,制作个性化钛修复体,虚拟设计颅骨外板取骨及移植方案,采取数字化成型的个性化钛修复体结合自体颅骨外板移植修复颅骨骨纤病灶切除后的颅骨缺损。3、重建颅眶部骨纤维异常增殖症术前与术后的眶内容,测量眶容积和突眼程度,进行统计分析。4、测量并计算骨纤维异常增殖症病灶区骨密度值,在骨密度可信区间内限定重建阈值,重建病灶区,测量术后2周内和术后半年的病灶体积,进行数据分析。结果1、患侧病灶所致眶底抬高的眼眶畸形得到矫正并接近健侧,患侧颌面部经修复后接近健侧形态,患者及家属表示满意；术中出血量少,未发生误伤神经血管等并发症；术后骨形态接近术前模拟效果。2、术后重建的颅眶部形态接近正常,患者及家属表示满意,术后无严重并发症。3术后患侧眶容积和突眼度均有改善,眶容积与突眼度间为正相关。4、可检测到研究组内部分病例术后术后2周内和术后半年的病灶体积间的差异。结论采用数字化技术辅助治疗颅面部骨纤维异常增殖症,术后面部形态良好,并发症少,术后颅骨形态接近术前的模拟效果。手术可以改善眶部骨纤维异常增殖症造成的眶腔狭窄和突眼畸形,同时眶容积与突眼度间存在相关性。采用限定骨密度法测量病灶体积,可以反映病灶生长速度,为骨纤维异常增殖症的随访诊断提供定量数据。更多还原

【Abstract】 Objective:1. To explore an easy method of digital technology for better results and safer surgery to deal with zygoma-maxilla fibrous dysplasia.2.To offer data and design with digital technology for better results and safer surgery to deal with frontal-orbital fibrous dysplasia.3.To measure the orbital volume and extent of proptosis of orbital fibrous dysplasia. And to analyze the relationship between the two measurements.4.To offer data for follow-up examination of craniofacial fibrous dysplasia with quantitative measurement of lesions volume.Methods:1.Measurement region of lesion was got with mirror and subtraction technology, the measurement were used in operation to resect the lesion of orbital floor and zygoma-maxilla. To reconstruct infraorbital nerve and design subsection osteotomy line, Virtual result were showed with digital imaging technology.2. Virtual result of frontal-orbital fibrous dysplasia lesion was resected, To design surgical projection of calvarial defect repaired by cranial bone combined with make individual prefabricated titanium implant.3. The orbital volume and extent of proptosis were measured, statistical analysis was performed between the relationship of the orbital volume and proptosis.4.Bone mineral density was measured in the lesion region, the reconstruction threshold was defined in the confidence interval of the bone mineral density, statistical analysis was performed between the relationship of the volume of postoperative lesion in2weeks and the volume after half six monthsResults:1. There are minimal deference between the uninvolved side and the postoperative involved side, the orbital and facial deformities were corrected, and good aesthetic outcomes can be obtained with minimal risk.2.The shape of frontal bone and orbit were similar to normal state post operation with digital technology.3.The orbital volume was expanded and the proptosis was alleviated post operation. There are positive correlation between the orbital volume and extent of proptosis.4. There are difference between the volume of the volume of postoperative lesion in2weeks and the volume after half six months in some cases.Conclusions:Our experiences indicate that good functional and aesthetic outcomes can be obtained with minimal risk using this digital technology in surgical planning. The result of operation can be predicted with digital imaging technology. The orbital volume was expanded and the proptosis was alleviated post operation. There are positive correlation between the orbital volume and extent of proptosis. The speed of lesion increase can be measured in follow-up examination with bone mineral density method.更多还原