The Application of Computer-Aided Three-Dimensional Simulation and Prediction in Orthognathic Surgery (CASPOS) For Treating Dento-Skeletal PatientsORTHOGNATHIC SURGERY (CASPO日FOR TREATINGDENTO-SKELETAL P ATIENTS

應用3-D數位模型在預測模擬正顎手術結果精準度之研究

張毓仁(Yu-Jen Chang) ； 林秀雄(Shiu-Shiun Lin) ； 吳德儒(Te-Ju Wu) ； 蔡文卿(Wen-Ching Tsai) ； 許為勇(Wei-Yung Hsu) ； 賴瑞斌(Jui-Pin Lai)

《中華民國齒顎矯正學雜誌》 25卷2期 (2013/06) Pp. 93-102

https://doi.org/10.30036/TJO.201306_25(2).0003

摘要

目的：電腦輔助顱面重建已經發展到能允許外科醫師精準地模擬和預測複雜的3-D顱顏結構的手術結果。我們已經開發出一種可以應用在正顎手術上新的3-D模擬及預測方法（3-D Computer-Aided Simulation and Prediction in Orthognathic Surgery- CASPOS Protocol）不僅使臨床醫師可以計劃及模擬手術過程，而且還提供了一個骨骼定位導引板，能夠精準地將模擬結果轉移到術前規劃的位置。本篇研究的目的是評估CASPOS模擬和預測的準確性。材料及方法:選用了15位嚴重的骨骼性異常咬合的成人患者，其都接受矯正合併上下顎正顎手術治療。術式皆是上顎勒福一型截骨術（LeFort I osteotomy）合併雙側下顎枝矢向分裂骨切開術（bilateral sagittal split osteotomy）。手術後上下顎固定期為兩週。手術前所有的齒列矯正移動皆完成後，於術前三周前進行電腦斷層掃描。手術模擬和預測皆根據CASPOS的模擬結果執行。手術結果是藉由術後6個月的斷層掃描來評估。CASPOS的準確性評估是對照手術前和手術後的電腦斷層掃描數據之間的差異。結果：患者手術後的臉型，表現出顯著的改善。手術的骨頭移動都符合與模擬的距離及以及方向。本研究中術前模擬預測與手術治療結果的三度空間參數之平均差異值在±0.589毫米的範圍內，顯示手術治療結果皆能與術前規劃之模擬預測一致。結論：本研究中應用CASPOS預先設計的手術導引板在治療顱顏患者上，可以給予外科醫師精確地處理複雜的骨骼畸形。我們的CASPOS技術提供了一種新的方法，使臨床相關人員能精準地改正患者複雜顱顏差異。

關鍵字

電腦輔助 ； 顱顏 ； 導航 ； 預測 ； 正顎手術 ； 模擬

並列摘要

AIM: Computer-aided craniofacial reconstructions have been developed to allow surgeons to accurately simulate and predict the surgical outcome on complicated 3-D craniofacial structures. We have developed a new computerized method of 3-D simulation and prediction in orthognathic surgery (CASPOS) that not only enables clinicians to plan and simulate the surgical procedures, but also provides a bony ”guiding splint” to allow surgeons to precisely position the bony segments into the planned location. This study is aimed for assessing the accuracy of simulation and prediction of our CASPOS protocol.MATERIALS AND METHOD: Fifteen adult patients with severe dento-skeletal discrepancies treated with orthodontics and 2-jaw orthognathic surgery were selected. They were all managed with maxillary LeFort I osteotomy and mandibular bilateral sagittal split osteotomy. Post-surgical fixation lasted for 2 weeks. Pre-surgical CT scan was carried out 3-week before surgery after all the required orthodontic movement was completed. The surgical simulation and prediction were executed according to our CASPOS protocol. The surgical outcome was assessed by CT scan taken 6 months after surgery. The accuracy brought by CASPOS was evaluated by comparing the differences between prediction and post-surgical CT data.RESULT: The post-surgical profile of patients showed significant improvement. The surgical bony movements all complied with those of simulation in terms of magnitudes and directions. The outcome demonstrated the satisfactory result, and the means of geographical summation error in this study were within the range of ±0.589mm.CONCLUSION: The application of CASPOS protocol with pre-designed bony guiding splint in treating craniofacial patients in this study can grant surgeons to precisely manage the complicated skeletal deformities. Our CASPOS technique provides a novel approach for orthodontists and surgeons to accurately remedying the patients with complex craniofacial discrepancies.

並列關鍵字

Computer-Aided ； Craniofacial ； Navigation ； Prediction ； Orthognathic Surgery ； Simulation