," /> ,"/> 下颌前突畸形患者上颌骨及髁突虚拟位置与术后现实位置的比较
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北京大学学报（医学版） ›› 2024, Vol. 56 ›› Issue (1): 74-80. doi: 10.19723/j.issn.1671-167X.2024.01.012

• 论著 • 上一篇    下一篇

下颌前突畸形患者上颌骨及髁突虚拟位置与术后现实位置的比较

蔡安东1,2,王晓霞1,*(),周文娟3,柳忠豪2,3,*()   

  1. 1. 北京大学口腔医学院·口腔医院口腔颌面外科，国家口腔医学中心，国家口腔疾病临床医学研究中心，口腔生物材料和数字诊疗装备国家工程研究中心，口腔数字医学北京市重点实验室，北京 100081
    2. 滨州医学院口腔医学院，数字化口腔医学山东省高校特色实验室，山东烟台 264003
    3. 滨州医学院附属烟台口腔医院，数字化口腔医学技术烟台市工程研究中心，山东烟台 264000
  • 收稿日期:2023-09-18 出版日期:2024-02-18 发布日期:2024-02-06
  • 通讯作者: 王晓霞,柳忠豪 E-mail:doctorwang66@sina.com;dentlzh@163.com
  • 基金资助:
    北京大学口腔医院临床新技术新疗法项目(PKUSSNCT23AO2)

Comparison of the virtual surgical planning position of maxilla and condyle with the postoperative real position in patients with mandibular protrusion

Andong CAI1,2,Xiaoxia WANG1,*(),Wenjuan ZHOU3,Zhonghao LIU2,3,*()   

  1. 1. Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
    2. Characteristic Laboratories of Colleges and Universities in Shandong Province for Digital Stomatology, School of Stomatology, Binzhou Medical University, Yantai 264003, Shandong, China
    3. Yantai Engineering Research Center for Digital Technology of Stomatology, The affiliated Yantai Stomatological Hospital, Binzhou Medical University, Yantai 264000, Shandong, China
  • Received:2023-09-18 Online:2024-02-18 Published:2024-02-06
  • Contact: Xiaoxia WANG,Zhonghao LIU E-mail:doctorwang66@sina.com;dentlzh@163.com
  • Supported by:
    the Program for New Clinical Techniques and Therapies of Peking University School and Hospital of Stomatology(PKUSSNCT23AO2)

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摘要：

目的: 对比数字化正颌外科手术方案中上颌骨及髁突的虚拟位置与术后现实位置的差别，探究术前虚拟设计在术中实现的程度。方法: 选择2022年1—12月于北京大学口腔医院采用数字化正颌手术方案行双颌手术的骨性Ⅲ类下颌前突畸形患者36例，收集患者术前数字化正颌手术方案(T0)和术后1周CT数据(T1)，使用CCMF Plan软件对术后CT数据进行三维建模并替换术后模型中的牙列数据，将颅骨解剖结构与术前虚拟设计模型进行匹配，选取髁突及上颌骨的解剖标志点及其连线，对比标志点在三维方向上的坐标变化以及标志点连线与参考平面的角度变化，分析术后髁突及上颌骨位置相对虚拟设计中的位置偏差。结果: 术后上颌骨实际位置与虚拟设计位置在水平向及垂直向的偏差为1 mm左右，前后向偏差约为1.5 mm。术后双侧髁突与虚拟设计位置相比，大多发生向前、向外、向下的移动(平均距离分别为0.15 mm、1.54 mm、2.19 mm)及向前、向外、向上的旋转(平均角度分别为4.32°、1.02°、0.86°)。结论: 采用3D打印咬合导板辅助可较好实现数字化手术方案的虚拟设计，但与术后颌骨的实际位置存在一定误差，可能与虚拟设计中下颌旋转轴有关，提示有必要采用患者个性化髁突旋转轴进行数字化正颌手术方案的规划，并采用髁突定位装置来提高手术操作的精确性。

关键词: 数字技术, 正颌外科手术, ')">安氏Ⅲ类错

Abstract:

Objective: To compare the difference between virtual surgical planning (VSP) position and postoperative real position of maxilla and condyle, and to explore the degree of intraoperative realization of VSP after orthognathic surgery. Methods: In this study, 36 patients with mandibular protrusion deformity from January 2022 to December 2022 were included. All the patients had been done bilateral sagittal split ramus osteotomy (SSRO) combined with Le Fort Ⅰ osteotomy under guidance of VSP. The VSP data (T0) and 1-week postoperative CT (T1) were collected, the 3D model of postoperative CT was established and segmented into upper and lower jaws in CCMF Plan software. At the same time, accor-ding to the morphology of palatal folds, the virtual design was registered with the postoperative model, and the unclear maxillary dentition in the postoperative model was replaced. Then the postoperative model was matched with VSP model by registration of upper skull anatomy that was not affected by the operation. The three-dimensional reference plane and coordinate system were established. Selecting anatomical landmarks and their connections of condyle and maxilla for the measurement, we compared the coordinate changes of marker points in three directions, and the angle changes between the line connecting the marker points and the reference plane to analyze the positional deviation and the angle deviation of the postoperative condyle and maxilla compared to VSP. Results: The postoperative real position of the maxilla deviates from the VSP by nearly 1 mm in the horizontal and vertical directions, and the anteroposterior deviation was about 1.5 mm. In addition, most patients had a certain degree of counterclockwise rotation of the maxilla after surgery. Most of the bilateral condyle moved forward, outward and downward (the average distance deviation was 0.15 mm, 1.54 mm, 2.19 mm, respectively), and rotated forward, outward and upward (the average degree deviation was 4.32°, 1.02°, 0.86°, respectively) compared with the VSP. Conclusion: VSP can be mostly achieved by assistance of 3D printed occlusal plates, but there are certain deviations in the postoperative real position of maxilla and condyle compared with VSP, which may be related to the rotation axis of the mandible in the VSP. It is necessary to use patient personalized condylar rotation axis for VSP, and apply condylar positioning device to further improve surgical accuracy.

Key words: Digital technology, Orthognathic surgical procedures, Angle class Ⅲ malocclusion

中图分类号: 

  • R782.2

图1

虚拟设计与术后模型的配准及三维参考平面的建立"

表1

三维测量解剖标志点的定义"

Measurement landmarks T0 T1 Definition
Mesio-proximal point of maxillary central incisor U1 U1’ Mesial contact point of maxillary central incisor
Mesial buccal tip of left maxillary first molar U6L U6L’ Mesial buccal tip of left maxillary first molar
Mesial buccal tip of right maxillary first molar U6R U6R’ Mesial buccal tip of right maxillary first molar
Lateral pole of condyle A A’ Lateral most prominent point of condyle
Medial pole of condyle B B’ Medial most prominent point of condyle
Condylar center point D D’ The midpoint of the line between the inner and outer poles of the condyle
Sigmoid notch point C C’ The lowest point of sigmoid notch
Condylar neck point E E’ The concave point of the neck of the condyle
Apex of condyle S S’ The superior pole of condyle

图2

上颌距离偏差测量方法"

图3

髁突距离及角度偏差测量方法"

表2

数字化正颌方案设计与术后上颌骨实际位置的测量差值"

Items X Y Z
Left side deviation Right side deviation Upward deviation Downward deviation Anterior deviation Posterior deviation
U1/mm 1.18±1.24
(0.75, 1.61)		 -1.24±1.15
(-1.74, -0.75)		 1.27±1.10
(0.75, 1.80)		 -1.08±0.88
(-1.50, -0.66)		 1.75±1.39
(1.08, 2.42)		 -1.56±1.12
(-2.12, -1.00)
U6R/mm 1.16±1.32
(0.40, 1.93)		 -0.99±0.97
(-1.38, -0.59)		 0.94±0.81
(0.51, 1.37)		 -1.05±0.94
(-1.48, -0.63)		 1.15±1.06
(0.68, 1.62)		 -1.37±1.24
(-2.03, -0.71)
U6L/mm 1.06±0.88
(0.49, 1.62)		 -1.41±1.96
(-2.22, -0.60)		 0.53±0.51
(0.19, 0.87)		 -0.66±0.63
(-0.92, -0.39)		 1.55±1.08
(1.10, 2.01)		 -1.97±1.58
(-2.88, -1.06)
Overall deviation/mm 1.19±1.34
(0.94, 1.44)		 0.96±0.92
(0.69, 1.23)		 -0.93±0.82
(-1.14, -0.72)		 1.53±1.23
(1.31, 1.76)

表3

数字化正颌方案设计与正颌术后髁突实际位置的测量差值"

Items ΔD/mm ΔB/mm ΔS/mm α/(°) β/(°) θ/(°)
Left condyle 0.08±1.33
(-0.37, 0.54)		 2.16±1.49
(1.65, 2.67)		 -1.29±1.56
(-1.82, -0.75)		 4.35±2.80
(3.39, 5.32)		 1.29±2.15
(0.56, 2.03)		 -1.09±3.12
(-2.17, -0.20)
Right condyle 0.21±0.91
(-0.09, 0.52)		 -2.16±1.49
(-2.65, -1.67)		 -1.80±1.44
(-2.29, -1.32)		 4.29±2.32
(3.51, 5.08)		 0.85±2.23
(0.09, 1.62)		 -0.62±3.57
(-1.83, 0.59)
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ISSN 1671-167X
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