计算机辅助软组织预测技术在正颌外科手术中的应用

目的:探讨计算机辅助软组织预测技术在正颌外科手术计划中的应用,构建虚拟手术仿真平台.方法:随机选择1例下颌骨前突伴颏部后缩畸形的患者,术前行头部螺旋CT扫描,获得的容积数据信息以DICOM格式导入Mimics软件进行三维重建,获到颅骨及软组织的三维数字化模型.在此虚拟模型的基础上,模拟骨组织的切割、旋转和平移等手术操作,并预测相应手术的术后软组织变化.结果:应用该颅颌面三维数字化模型,模拟LeFort Ⅰ型截骨术、双侧下颌升支矢状劈开截骨术(BSSRO)和水平截骨颏成型术.通过上颌骨前移、下颌骨后缩获得理想咬合关系,应用前移与后退的不同数据模拟手术过程,预测术后颌面软组织的改变效果,设计最佳手术方案.结论:计算机辅助软组织预测技术能够快速整合多种医学影像数据信息,直观模拟手术设计与术后效果,为正颌外科矫治牙颌面畸形制定个体化最佳手术方案提供了实用有效的技术和依据.     

Mandibular retrusion, temporomandibular joint derangement, and orthognathic surgery planning.

One-hundred consecutive orthognathic surgery candidates with mandibular retrusion were selected for retrospective analysis. Patients had undergone imaging studies that included magnetic resonance imaging (MRI) of both temporomandibular joints to assess the presence or absence, stage, and activity of suspected internal derangement(s). Patients were divided into stable and unstable deformity groups based on the presence or absence of change in their facial contour and/or occlusal disturbances in the 24 months prior to evaluation. Each of the 58 unstable and 30 of 42 stable patients were found to have internal derangements of at least one temporomandibular joint. The degree of joint degeneration directly paralleled the severity of retrognathia in most cases. We concluded that temporomandibular joint internal derangement is common in cases of mandibular retrusion and leads to the facial morphology in a high percentage of patients. Preoperative temporomandibular joint imaging with MRI is recommended prior to orthognathic surgical correction of retrognathic deformities.     

限量灌溉下冬小麦水分利用效率模拟

用参数调试后的DSSAT-CERES Wheat模型,以郑州地区冬小麦全生育期降水偏缺的2003-2004年逐日气象资料为背景数据,在分析作物阶段缺水量的基础上,限定灌溉量100 mm以内,分不灌水、灌一水、二水、三水处理,着重模拟研究限量灌溉对冬小麦水分利用的影响,并引入田间水分管理反映指标(WMRIs)为优化灌溉方案设计提供综合评价参考.结果表明:限量灌溉可在一定程度上缓解水分胁迫,促进增产并提高水分利用效率;各种处理均较不灌水明显增产,增产率为13.1%～73.3%;小麦对水分的吸收利用总体表现为灌二水优于灌三水优于灌一水;水分利用效率越冬水+灌浆水最高,灌溉水利用效率拔节水最高;拔节期是限量灌溉的最佳时期.     

Detection of the hip center in computer-assisted surgery: An in vitro assessment study

The HKA i.e. the angle between the hip, knee and ankle centers is a clinical parameter widely used in orthopedic surgery. It can be intraoperatively assessed with computer-assisted surgery navigation systems by computing the 3D location of these joint centers. The hip center is computed using functional methods but is defined by the experts as the anatomical center of the femoral head. The aim of this in vitro study is therefore to assess, first, the accuracy of these functional methods for the determination of the HKA and, second, their reproducibility. We have analyzed on six cadaveric lower limbs the accuracy and the reproducibility of functional methods and their impact on the HKA values. The anatomical hip center has been used as the reference value. The reproducibility is 5.2 mm for the determination of the functional hip centers. The average impact on the HKA is 1.2° (4° max). Despite a lack of reproducibility of the functional methods, the impact on the HKA is limited. The accuracy of the functional methods on the HKA can therefore be enough for some clinical applications.     

Predictors of velopharyngeal insufficiency in cleft palate orthognathic surgery

The purpose of this study was to appraise the value of preoperative speech assessments, nasopharyngoscopy, and surgical models as predictors of velopharyngeal deterioration after a Le Fort I maxillary advancement in cleft patients. This retrospective study involved a series of 26 cleft patients (16 unilateral complete and nine bilateral complete cleft lips and palates, and one isolated complete cleft palate) who had Le Fort I maxillary advancements between March 1, 1993, and February 7, 1996. The 13 male patients and 13 female patients ranged in age from 15.3 to 46 years (mean age, 19.5 years). Four of these patients had previously undergone pharyngeal flap surgery. Eleven patients had palatal fistulas and one had a bifid uvula that was repaired at the time of orthognathic surgery. Patients with perceived hypernasal speech preoperatively all had hypernasality after advancement (nine of nine). Velopharyngeal insufficiency was observed in two of the 16 whose resonance preoperatively was within normal limits. Speech assessment, therefore, predicted accurately the postoperative status in 23 of 26 patients. Twelve patients had preoperative nasopharyngoscopy that indicated a high risk for velopharyngeal insufficiency (borderline or inadequate closure). Nine of these patients had postoperative velopharyngeal insufficiency. Two of the 14 patients not judged at risk by nasopharyngoscopy developed velopharyngeal insufficiency. Therefore, 21 of the 26 patients were accurately predicted by nasopharyngoscopy. Scoping detected borderline velopharyngeal insufficiency in one patient who was not detected by speech alone. The combined predictive value of speech and scope identified all but one patient who would develop postoperative velopharyngeal insufficiency. The degree of anteroposterior movement determined from surgical models was not predictive of the outcome. Patients with hypernasal speech preoperatively continue to have hypernasal speech after Le Fort I advancement. Preoperative perceptual speech assessment by specially trained speech-language pathologists is an excellent test for predicting postoperative velopharyngeal insufficiency status. Nasopharyngoscopy is an invasive and resource-dependent test that should be assessed with respect to cost effectiveness. In this series, only one patient's risk was more accurately predicted using nasopharyngoscopy than by speech assessment alone.     

Biological and surgical aspects of the use of polymers in experimental surgery. 1: implants on the oculo-extrinsic musculature

Composite sheets obtained reinforcing PHEMA with a tricot PET net have been implanted in rabbits to test their potential applications for cross-eye surgical correction. The mechanical characterization of the composites has been carried out both in static tension and fatigue. The clinical evaluation was performed on twelve adult New Zealand white Rabbits implanting the sheets on the rectus dorsalis muscle of the eye. The material seems to be highly compatible with the surrounding tissue, mechanical satisfying and clinically helpful in correcting many of the pathological conditions connected with strabismus. The long term behaviour of the implanted prosthesis in still under investigation.     

Increasing use efficiency of boron fertilisers by rescheduling the time and methods of application for crops in India

Boron-deficiency is prevalent in light-textured acidic soil regions receiving high precipitation. Crop use efficiency of fertiliser B is also low under such B-leaching environments. For high leaching regimes, we hypothesised that the optimal timing and method of B application would vary with the crop sensitivity to B-deficiency and periods of peak demand for B. The aim of the present experiment was to vary the timing and method of B application to increase use efficiency on typical B-deficient Entisols. Mustard (Brassica campestris L.), wheat (Triticum aestivum L.) and potato (Solanum tuberosum L.) were the test crops. There were seven treatment combinations of B, applied either to soil or as foliar sprays at different doses and growth stages of the crops. Biomass and yield related characters of the crops at harvest, B concentration in plants and its uptake increased with B application being highest in mustard, followed by potato and wheat. Foliar application, in general had higher economic benefits than soil application. Split application of B either to soil (as basal and 25 days after sowing) or foliar sprays (at 25 and 40 and 25 and 45 days after sowing for mustard and potato, respectively) had an edge over a single application. For wheat, a single late application of B (at 45 or 60 days after sowing through soil or foliar spray, respectively) was more effective than the early or split application in increasing yields. Better use efficiency of B can thus be achieved if it is applied late for wheat but in splits over a longer period for mustard and potato with higher economic benefits.     

Brain abscess as a complication of orthognathic surgery: diagnosis, management, and pathophysiology

We present what we believe is the first case of a brain abscess resulting from orthognathic surgery reported in the literature. Although recent advances have significantly improved the treatment of brain abscesses, delays in diagnosis lead to persistent high rates of mortality. Often, the initial symptoms are vague and nonspecific. Commonly, the neurologic status of the patient deteriorates significantly before suspicion is raised and a CT scan is obtained. This case report is intended to benefit all practitioners who participate in the perioperative care of orthognathic surgery patients. Although the occurrence of a brain abscess is rare, it is hoped that this case will heighten the awareness of clinicians to this potential complication.     

Three-dimensional computer-assisted design of craniofacial surgical procedures: optimization and interaction with cephalometric and CT-based models

A computer program is described which aids the clinician in planning craniofacial surgical procedures. It operates on a three-dimensional landmark data base derived by combining posteroanterior and lateral cephalograms from the patient and from the Bolton normative standards. A three-dimensional surgical simulation program based on computerized tomographic (CT) data is also described which can be linked to the cephalometrically based program. After the clinician has selected the number and type of osteotomies to be performed on the patient, an automated optimization program computes the postoperative positions of these fragments which best fit the appropriate normal cephalometric form. The clinician then interactively modifies the design to account for such variables as bone-graft resorption, relapse tendency, occlusal disparities, and the condition of the overlying soft-tissue matrix. Osteotomy movement specifications are easily transferred between the CT-based and the cephalometrically based surgical simulation programs. This allows the automated positioning step to be performed on the cephalometrically based model while the interactive step is performed using the superior image provided by the CT-based model.