颧骨复合体骨折手术复位标志点三维测量的临床应用

doi:10.3969/j.issn.1005-4979.2013.04.006

摘要/Abstract

摘要： 目的：筛选颧骨复合体表面标志点，建立单侧颧骨复合体骨折移位的CT测量方法。探讨运用颧骨复合体表面复位标志点指导骨折手术治疗的可行性，为临床治疗计划提供参考。方法：收集我科收治颌面部创伤患者的临床资料。选取其中影像资料完整的单侧颧骨复合体骨折29例进行研究。利用Mimics软件重新分析建模。从双侧颧骨复合体与邻近骨骼解剖标志点中，选取同样两点之间的距离进行测量分析。得到骨折段向后、向内、向下移位程度，进一步总结出颧骨复合体骨折后断段移位的规律，为复位手术提供参考。结果：筛选出眶额颧点、颧颌缝眶下缘点、颧颌缝点、颧突点、乳突点、颞骨根点，共6个解剖标志点，对29例单侧颧骨复合体骨折进行了多距离的测量，建立了单侧颧骨复合体骨折的数字化测量系统；重点对颧突点和颧弓突点进行了测量。测量结果发现颧骨复合体骨折时，颧骨体骨折块多向后、向内移位。骨折评分越高或者骨折移位程度越严重的，更需要手术复位。在内外方向上移位严重的，最具有明确手术指征，迫切需要进行手术复位。结论：利用三维CT数据创建三维数字模型，筛选出的6个解剖标志点可用于颧骨复合体骨折移位的测量，建立的颧骨复合体骨折的数字化测量方法可以指导临床。

关键词: 三维CT测量技术, 头影测量, 骨折, 颧骨复合体, 临床应用

Abstract: Objective: To find special anatomic landmarks in zygomatic maxillary complex (ZMC) in order to establish a reliable CT measuring method for quantitative diagnosis and management of unilateral ZMC fractures. Method： A total of 29 patients with hemilateral ZMC fractures were retrospectively reviewed and analyzed in this study. Segmentation of the DICOM files was performed using Mimics and the rendered 3-dimensional reconstruction was produced in STL format for rapid prototyping. Standard anatomy points from both sides of ZMC and adjacent bone were selected, a total of 6 points (fmo, oz, zm, mp, Ms, tp) were employed in this study. Distances of selected same points from both sides were measured by Mimics software. The degree of displacement of the zygomatic segment to backward, inward and downward were obtained, and the digital measurement system of ZMC fracture was established. Results： Measurement results showed that the displacement of the zygoma segment in most patients was backward and inward. Higher fracture scores, and/or severe displacement in one or more dimensions were more likely to require operative reduction. Conclusion: This study suggest that using the three-dimensional CT data to construct a 3D reconstruction model and selected 6 anatomical landmarks can be used for the measurement of displacement of ZMC and a guidance for surgical reduction.

Key words: three dimensional CT measurement, cephalometric, fracture, zygomatic maxillary complex, clinical application

中图分类号:

R782.4

曾勇，张萍，李鹏飞，陈勇，张纲. 颧骨复合体骨折手术复位标志点三维测量的临床应用[J]. 《口腔颌面外科杂志》, 2013, 23(4): 257-260.

ZENG Yong, ZHANG Ping, LI Peng-fei, CHEN Yong, ZHANG Gang. The Role of 3D Computed Topography in the Design and Management
of Zygomatic Maxillary Complex Fracture[J]. 《Journal of Oral and Maxillofacial Surgery》, 2013, 23(4): 257-260.

https://journal06.magtech.org.cn/Jweb_joms/CN/Y2013/V23/I4/257

参考文献

[1] Erdmann D, Follmar KE, Debruijn M, et al. A retrospective analysis of facial fracture etiologies [J]. Ann Plast Surg, 2008, 60(4):398-403.

[2] Chen X, Lin Y, Wang C， et al. A surgical navigation system for oral and maxillofacial surgery and its application in the treatment of old zygomatic fractures [J].Int J Med Robot, 2011, 7(1):42-50.

[3] Manson PN, Stanwix MG, Yaremchuk MJ, et al. Frontobasal fractures: anatomical classification and clinical significance [J].Plast Reconstr Surg, 2009, 124(6):2096- 2106.

[4] Nowinski D, Messo E, Hedlund A, et al. Treatment of orbital fractures： evaluation of surgical techniques and materials for reconstruction[J]. J Craniofac Surg, 2010, 21(4): 1033-1037.

[5] Stanley RB Jr. Use of intraoperative computed tomography during repair of orbitozygomatic fractures [J]. Arch Facial Plast Surg, 1999, 1 (1):19-24.

[6] Gülicher D, Krimmel M, Reinert S, et al. The role of intraoperative ultrasonography in zygomatic complex fracture repair [J].Int J Oral Maxillofac Surg, 2006, 35(3):224-230.

[7] Barry C, Coyle M, Idrees Z, et al. Ocular findings in patients with orbitozygomatic complex fractures: a retrospective study [J]. J Oral Maxillofac Surg, 2008, 66(5):888-892.

[8] Gomes PP, Passeri LA, Barbosa JR, et al. A 5-year retrospective study of zygomatic-orbital complex and zygomatic arch fractures in Sao Paulo State, Brazil [J]. J Oral Maxillofac Surg, 2006, 64(7):63-67.

[9] de Moraes ME, Hollender LG, Chen CS， et al. Evaluating craniofacial asymmetry with digital cephalometric images and cone-beam computed tomography[J]. Am J Orthod Dentofacial Orthop, 2011, 139(6): e523-e531.

[10] Hoeffner EG, Quint DJ, Peterson B, et al. Development of a protocol for coronal reconstruction of the maxillofacial region from axial helical CT data[J]. Br J Radiol, 2001, 74(880):323-327.

[11] Ohkawa M, Tanabe M, Toyama Y, et al. The role of three-dimensional computed tomography in the management of maxillofacial bone fractures [J]. Acta Med Okayama, 1997, 51(4):219-225.

[12] Gomes PP, Passeri LA, Barbosa JR. A 5-year retrospective study of zygomatic orbital complex and zygomatic arch fractures in Sao Paulo State, Brazil [J]. J Oral Maxillofac Surg, 2006, 64(1):63-67.

[13] Kaufman Y, Stal D, Cole P, et al. Orbitozygomatic fracture management [J]. Plast Reconstr Surg, 2008, 121(4):1370-1374.

[14] Back CP, McLean NR, Anderson PJ, et al. The conservative management of facial fractures: indications and outcomes [J]. J Plast Reconstr Aesthet Surg, 2007, 60(2):146-151.

[15] Dos Santos DT, Costa e Silva AP, Vannier MW, et al.Validity of multislice computerized tomography for diagnosis of maxillofacial fractures using an independent workstation [J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2004, 98(6):715-720.

[16] Pan CY, Barrear JE, Kwon J,et al. Three-dimensional analysis of zygomatic-maxillary complex fracture patterns[J]. Craniomaxillofac Trauma Reconstr, 2010, 3(3): 167-176.

[17] de Moraes ME, Hollender LG, Chen CS, et al. Evaluating craniofacial asymmetry with digital cephalometric images and cone-beam computed tomography[J]. Ann J Orthod Dentofacial Orthop, 2011, 139(6): e523-e531.

[18] Silva DN, Gerhardt de Oliveira M, Meurer E, et al. Dimensional error in selective laser sintering and 3D-printing of models for craniomaxillary anatomy reconstruction [J]. J Craniomaxillofac Surg, 2008, 36(8): 443-449.

[19] Terajima M, Nakasima A, Aoki Y, et al. A 3-dimensional method for analyzing the morphology of patients with maxillofacial deformities [J]. Ann J Orthod Dentofacial Orthop, 2009, 136(6): 857-867.

[20] Pham AM, Rafii AA, Metzger MC, et al. Computer modeling and intraoperation navigation in maxillofacial surgery [J]. Otolaryngol Head Neck Surg, 2007, 137(4):624-631.

选择文件类型/文献管理软件名称

选择包含的内容