CN105608741A - Computer simulation method for predicting soft tissue appearance change after maxillofacial bone plastic surgery - Google Patents
Computer simulation method for predicting soft tissue appearance change after maxillofacial bone plastic surgery Download PDFInfo
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Abstract
The invention belongs to the computer aided surgical technique and maxillofacial plastic medical treatment equipment field and relates to a computer simulation method for predicting soft tissue appearance change after a maxillofacial bone plastic surgery. The method comprises the following steps that: spiral CT scanning is performed on the maxillofacial of a patient before the surgery; data are led into maxillofacial surgery design simulation software, namely, CMF-pre CADS, so that a three-dimensional maxilla and skin surface model is re-constructed; a bone segment is reset/shifted to a preliminary location; and the similarity of a pre-surgery prediction model and a post-surgery true appearance is judged through comparison through Geomagic software. With the method adopted, the post-surgery appearance and stomatognathic system functions can be recovered excellently; the appearance of soft tissues are symmetrical, harmonious and beautiful; the post-surgery satisfaction degree of the patient reaches 95%; the effects of the plastic surgery are stable; and long-term satisfaction is also very high.
Description
Technical field
The present invention relates to Computer assisted surgery and craniofacial orthopedics field of medical, relate in particular to outside prediction jaw faceThe computer emulation method that after section's operation, soft tissue appearance changes.
Background technology
Along with the development of evidence-based medicine EBM and minimally invasive surgery, in decorative sursery, accurate preoperative plan becomes more and more important.Grow in research, wound repair and beauty and shaping therapeutic process the three-dimensional modeling of soft or hard tissue, measurement in jaw facial growth simultaneouslyAnalysis and surgical effect emulation are prerequisite and the key of digitlization Design, and wherein the prediction of soft tissue appearance is particularly important. ForObtain best surgical effect, decorative sursery operation often need doctor in the preoperative can be according to the art formula of intending taking, osteotomy position, cutThe direction that bone amount and bone section move, predicts the face metamorphosis result after operation in patients. For plastic surgery, by softTissue simulation can be carried out preoperative assessment to various operation plans, thereby provides important reference to comply with for optimizing operation planAccording to, be also to carry out doctors and patients' interchange, obtain the support of patient to operation plan and the important means of understanding. According to another report, Ji HusuoThere is the Maxillofacial surgery patient through pre-operative surgical simulation and appearance prediction, obtained good communication because it is preoperative with doctor, long-pendingThe utmost point participates in deciding through consultation of surgical planning. Therefore after surgery surgical effect is generally pleased oneself. But how just can be accurate before operationSoft tissue appearance after true predicting surgical changes, and is the hot topic that biomedical worker and clinicians are concerned about and study alwaysOne of problem.
Due to the labyrinth of human body face skin soft tissue, its biomechanical property is difficult to measure, and determines Deformation LawMore complicated. It not only depends on direction, the distance that bone piece moves, and relevant with type of surgery, modus operandi, also has simultaneouslySome other factorses: thickness, elasticity, the quality of art district soft tissue; The thickness of skin, subcutaneous fat; Subcutaneous fascia have that it's too lateIts connected mode; The tension effect of soft tissue; Thickness and the type of art district peripheral region soft tissue; Scar and patient age,Races etc. are relevant. In Soft Tissue Deformation process, need the database of soft tissue to bone tissue proportion of deformation relation, and this distortionRule must obtain by clinical jaw face patient's retrospective study. Surgery Simulation has merged medical image, computer graphicShape and Mathematical Modeling etc. are multidisciplinary. The soft tissue model that the prognosis modelling of soft tissue is set up must have soft tissue simultaneouslyAnatomical features and biomethanics behavioral trait, particularly for the complicated nonlinear deformation behavior of soft tissue, needThe model more by setting up with physical third dimension is simulated. There is scholar to sum up at present multiple effective deformation mould in the worldType, is divided into two classes by them: network model and without grid model, the former comprise long model of element, Mass-spring model,Finite Element Method, Element BEM, tensor-Mass Model etc., the latter comprises particIe system, limited ball method, smooth particle fluxBody dynamics method, transfer chain model etc.
Early stage appearance prediction is to realize by two-dimentional manual outline or plane tracing, and it is to be based upon tradition mostlyX-ray head shadow lateral projection basis on, according to the amount of movement geometric ratio of maxillofacial bone bone realize soft tissue change, cannot reflect faceThe 3 D stereo of profile changes. And cranium Snorer complexity, its facial shape are not completely symmetrical, make to throw at x-rayAccording to the accuracy that has affected conventional two-dimensional surgical simulation and outcome prediction on left and right sides overlap problem. In recent ten years, American-European sending outReach national scientific research institution and dropped into the exploitation of a huge sum of money for cranium jaw face three-dimensional reconstruction and ASS. At present, the worldOn have a few money simulation systems of certain popularity comprise QuickCeph (QuickCephSystems, SanDiego,Calif.QC) system, DentoFacialPlanner (DentofacialSoftware, Toronto, Ontario,Canada.DFP), OrthognathicPredictionAnalysis (OPAL) and OrthognathicTreatmentPlanner (GACInternational, Birmingham, Ala) system etc. The major defect of existing simulation softward systemBeing: 1). the simulation algorithm of use is the statistical result after analyzing based on a large amount of geometrical models, does not set up high-precision thingReason parameter model, the Soft Tissue Deformation effect that this algorithm draws is the approximation of physiological property; 2). the statistics of algorithmMostly data are to derive from the experimental data of west ethnic group, and are not suitable for our east crowd; 3). in registration process, beSystem error undoubtedly can impact prediction accuracy. Utilize Computerized three-dimensional measurement and automation model manufacturing technology to simulate in advanceSurvey, even in the developed country of technology maturation, because its fancy price is also difficult to obtain clinically universal. Add its supporting establishingStandby expensive, to be difficult to carry and buy module only can be used as Three-dimensional Display and cannot edit or the further feature such as exploitation, moreCannot be promoted clinically at home. Therefore, seek a kind of analog simulation that there is height emulation and be convenient to clinical practiceMethod await further discussion.
Up to now, still lack both at home and abroad a kind of desirable, comprehensively three-dimensional modeling method and soft tissue deformation simulation imitativeTrue platform.
Summary of the invention
In order to solve above technical problem, the present invention researched and developed a kind of applicable east crowd, for oral and maxillofacial surgery and U.S.Hold emulation platform and the method flow of the orthopedic preoperative appearance of soft tissue in the works prediction and operation on soft tissue.
Solve the computer that soft tissue appearance changes after the prediction maxillofacial bone orthopedic in the present invention of above technical problemEmulation mode, comprises master and slave computer system, computer simulation software bag and computer operating system, master and slave computer systemComprise and be positioned at the PC computer on foreground and the work station on backstage, and with the supporting emulator of emulation, it is characterized in that, comprise withLower step:
(1) obtain data: preoperative patient's jaw face spiral CT machine is carried out to CT scan, obtain DICOM data; To patientFace carries out 3 D stereo shooting with FaceSCAN3D face three-dimensional camera shooting instrument, obtains Obj. formatted data;
The prerequisite of computer virtual simulation is to set up the threedimensional model similar to actual object height, can be accurate by CT dataSet up the threedimensional model of maxillofacial bone bone sclerous tissues, CT data can be saved as to DICOM form baking tray for subsequent use; Adopt FaceSCAN3DCan obtain Deng human body face 3 D stereo video camera the there is textural characteristics height of (can characterize skin colour, the information such as quality)The three dimensional face model of fidelity, i.e. three-dimensional stereo photo demonstrates final soft tissue deformation effect on stereoscopic photograph.
(2) DICOM data and Obj. formatted data are imported to Maxillofacial surgery design and simulation software-CMF-preCADS, rebuildThree-dimensional jawbone, skin surface model, and merge with three-dimensional stereo photo registration, set up the thin-skinned sclerous tissues of jaw deformation physical model,Be three-dimensional finite element and Mass-spring model association, the linear elasticity Deformation Law of simulation of facial skin;
Utilize CT data cutting apart in module (segmentation), use threshold value to choose (Thresholding), region growingEtc. (RegionGrowing) tool operation separates jawbone, skin covers cover (Mask), re-uses the complete reconstruction of Calculate3DJawbone and skin of face three-dimensional geometry surface model, the key factor of its reconstruction is to select correct threshold range, jawbone is commonBe 220～2900, skin is-700～-200HounsField unit, and wherein skin covers cover needs to use " filling hole "Fillinghole and an iteration " smoothly " smoothing instrument, make the skin curved surface complete and smooth of rebuilding, without step andArtifact, is convenient to do accuracy registration with three-dimensional stereo photo and merges.
CT rebuilds the registration technology of mask and three-dimensional stereo photo, use be 7 manual registration+ICP(iterativeclosestpoint, iterative closest point) automatic algorithms, two model error precision after registration merges canReach in 0.80mm, in the error range that naked eyes can be differentiated clinically. After Model registration, enter foundation height true to natureIn the software module of the thin-skinned sclerous tissues of the jaw deformation physical model of degree.
(3) on the three-dimensional jawbone model of the foundation in step (2), cut apart the fracture site of displacement or by orthognathic surgery markAccurate art formula separates bone section, and reset or displacement bone break to a preliminary position;
This preliminary position judges according to oneself clinical experience in the past by patient, and utilizing provides in software Simulation moduleRotation (rotation) and translation (translation) instrument, the selected bone moving that needs breaks, and uses mouse manual operation or establishesDetermine shift parameters (the XYZ axle with local coordinate system is determined orientation), complete maxillofacial bone bone virtual operation.
(4) according to the algorithm of programming, then calculate jawbone sclerous tissues with software and move rear corresponding soft tissue curved surface and change;
CMF-preCADS software has the functional module of simulation soft tissue deformation: according to programmed algorithm and default parameter, calculateGo out jawbone sclerous tissues and move rear corresponding soft tissue curved surface variation, and the result of variation is presented to the 3 D stereo of high fidelityOn photo. The model of setting up in this software can be converted into the height based on three-dimensional finite element and Mass-spring model unified algorithmPrecision physical model.
(5) doctor and patient jointly measure and determine distortion after soft tissue appearance;
According to aesthstic golden section principle, five, facial three front yard face long aesthstic ratio and the modern aesthetic standard wide with face, doctorSuffer from the common objective measurement of both sides and subjective determination and consult, whether the soft tissue appearance after distortion is satisfied with, whether reach symmetrical, associationTune, attractive in appearance.
Be beneficial to doctors and patients and exchange, understand, before operation in patients, play an active part in the formulation of surgical planning, and propose rationally building of oneselfView, doctor and patient is revised distance and the position that bone moves jointly, and predicts appearance profile, until reach the art that both sides are satisfied withRear effect, has formulated final operation plan and (has comprised the position angle of osteotomy line, the disconnected distance angle that needs mobile rotation of boneParameter, the interior fixed configurations of preformed titanium plate etc.).
(6) the reconstruction of three-dimensional model behind bone offset position is saved as to STL formatted file, then import operation guiding systemIn the subsidiary software I-plan of BrainLAB institute, do preoperative air navigation plan, in art, instruct the accurate enforcement of virtual plan; Finally reachTo strengthening doctor patient communication and understanding, improve the object of patient satisfaction.
The model designing is with the disconnected information of bone that need to be shifted, and it is combined with real-time navigation equipment can be by preoperative voidIntend planning accurately to implement in operation, obtain the soft tissue face that we finally wish; In addition, virtual plan also can be passed throughSurgical template technology is implemented, and at (4) programming phase, utilizes CAD Software for Design reset guide plate, prints guide plate entity at 3DIn art, instruct osteotomy site and displacement bone disconnected.
(7) the postoperative 3-6 month is carried out 3 D stereo shooting again to patient's face, obtains real face number after operation in patientsAccording to, utilize Geomagic software contrast verification, the similarity of preoperative forecast model and postoperative true face, similarity 95% withWhen upper, showed that preoperative prediction was accurate, wherein similarity is recently weighed with the percentage of≤2mm tri patch.
The collection of postoperative patient image data need to be identical with technology with preoperative use equipment, avoids sampling error. ForPostoperative sampling time point can not be long or too short, need to consider swelling, the hemotoncus of postoperative soft tissue, and weight in patients changes, boneThe multiple factors that affect face profile such as offset position recurrence, sampled point is after surgery between the 3-6 month. In verification step, preoperative predictionModel and postoperative true model need registration analytical error, adopt equally the associating registration of 7 manual registration+ICP automatic algorithmsMethod. Also can adopt the method for subjective assessment, allow patient or trained doctor carry out phase to two stereoscopic photographsClassification like degree is judged.
Implement the method for operation and checking forecasting accuracy according to preoperative virtual plan, pre-to this soft tissue of clinical implementationThe meaning of survey technology and practicality have important influence.
In step described in prioritization scheme (1) CT scan scope be margo supraorbitalis to hyoid bone level, resolution ratio is 512 × 512,Bed thickness≤0.9mm, scanning voltage and electric current are respectively 140kV and 220mAs.
In described step (4), calculate jawbone sclerous tissues with software and move rear corresponding soft tissue curved surface variation, and will becomeThe result of changing shows with facial three-dimensional stereo photo.
Further, in prioritization scheme, in described step (4), first utilize facial finite element deformation physical model prediction jawbone to moveMoving postoperative soft tissue appearance changes, and calculates jawbone sclerous tissues and moves rear corresponding soft tissue curved surface variation, and will become with softwareThe result of changing shows with facial three-dimensional stereo photo.
In described step (5), doctor and patient is common measures and determines and the soft tissue appearance after distortion repeat (3) (4) stepUntil doctor and patient is consistent. According to the preoperative effect of predicting soft tissue appearance on three-dimensional stereo photo, adjust osteotomy line and changeBecome the disconnected multiple bit position of bone, until reach facial both sides soft tissue profile symmetry, attractive in appearance, doctor and patient is satisfied to postoperative face.
The present invention, by the prediction of implement software soft tissue appearance, programmes by computer mathematics, sets up and has physical attributeSoft or hard organize deformation model, i.e. three-dimensional finite element and Mass-spring model association, the nonlinear elasticity of simulation of facial skinDeformation Law.
The object of maxillofacial bone plastic operation is except the good function of recovery stomatognathic system, and another free-revving engine is to improveWith reparation patient deformity/asymmetric soft tissue appearance. The present invention on the basis of jaw face picture and anatomical documentation large data sets,Corresponding soft tissue situation of change after prediction maxillofacial bone movement of tissue, and implement by digitlization surgical technic in actual operationPreoperative plan. The present invention directly need to recover the object of soft tissue profile for operation, design osseous surgery scheme, makes to go smoothlyArt effect has better " predictable ", more easily obtains patient's understanding and cooperation, with respect to traditional dependence craniofacial orthopedicsSurgical clinical experience, this method can obtain better surgical effect.
The virtual plan of the bone plastic operation in the present invention is to design by the soft tissue appearance of accurately predicting, presses so farThe maxillofacial bone plastic operation patient that method is carried out the prediction of soft tissue appearance and realize virtual design under navigation is auxiliary like this, its artAfter facial appearance and stomatognathic system function all recover well, soft tissue profile symmetry, coordination, attractive in appearance, patient's Postoperative SatisfactionReach more than 95%, and orthopedic effect stability, long-term satisfaction is also very good.
Figure of description
Fig. 1 is the method flow diagram in the present invention
Detailed description of the invention
Disclosed all features in this description, or step in disclosed all methods or process, except mutually exclusiveFeature and/or step beyond, all can combine by any way.
In below implementing, human body face anatomical data data source used is in the Oral and Maxillofacial Surgery digitlization of West ChinaHuman body jaw face normal images data and maxillofacial trauma disease database based on XNAT framework that the heart is set up.
Embodiment 1.
Predict the computer emulation method that soft tissue appearance changes after decorative sursery operation, comprise master and slave computer system,Computer simulation software bag and computer operating system, master and slave computer system comprises and is positioned at the PC computer on foreground and backstageWork station, and with the supporting emulator of emulation, it is characterized in that: comprise the following steps:
(1) preoperatively patient's jaw face is carried out to CT scan with spiral CT instrument, obtain high-precision DICOM data; To patientFace carries out 3 D stereo shooting with FaceSCAN3D face three-dimensional camera shooting instrument, obtains Obj. formatted data; Computer virtual is imitativeGenuine prerequisite is to set up the threedimensional model similar to actual object height, can set up accurately hard group of maxillofacial bone bone by CT dataThe threedimensional model of knitting; Adopt the 3 D stereo video camera such as FaceSCAN3D to obtain to have textural characteristics high fidelity threeDimension mask, i.e. three-dimensional stereo photo shows final soft tissue deformation effect on stereoscopic photograph.
The prerequisite of computer virtual simulation is to set up the threedimensional model similar to actual object height, can essence by CT dataThe true threedimensional model of setting up maxillofacial bone bone sclerous tissues, CT scan require be: scope be margo supraorbitalis to hyoid bone level, resolution ratio is512 × 512, bed thickness≤0.9mm, scanning voltage and electric current are respectively 140kV and 220mAs, and CT data are saved as to DICOM latticeFormula baking tray is for subsequent use; Adopt the human body face 3 D stereo video camera such as FaceSCAN3D to obtain to there is textural characteristics and (can showLevy skin colour, the information such as quality) the three dimensional face model of high fidelity, i.e. three-dimensional stereo photo, makes final soft tissueDeformation effect shows on stereoscopic photograph.
(2) by CT and three-dimensional stereo photo data importing Maxillofacial surgery design and simulation software-CMF-preCADS, utilize CTThe three-dimensional jawbone of data reconstruction, skin surface model, and merge with three-dimensional stereo photo registration, set up and there is face texture characteristic, the thin-skinned sclerous tissues of the jaw three-dimensional finite element model of high fidelity.
That the registration technology of mask is used is 7 manual registration+ICP(IterativeClosestPoint, repeatedlyFor closest approach) automatic algorithms, two model error precision after registration merges can reach 0.77mm, far away from naked eyes can clinicallyIn the error range of differentiating.
By CT and three-dimensional stereo photo data importing Maxillofacial surgery design and simulation software-CMF-preCADS. Cutting apart module(segmentation) in, utilize CT data, use threshold value to choose (Thresholding), region growing (RegionEtc. Growing) tool operation separates jawbone, skin covers cover (Mask), re-uses the complete reconstruction jawbone of Calculate3D and facePortion's skin three-dimensional geometry surface model, the key factor of its reconstruction is to select correct threshold range, jawbone is generally 220～2900, skin is-700～-200HounsField unit, and wherein skin covers cover needs to use " filling hole " fillingHole and an iteration " smoothly " smoothing instrument, make rebuild skin curved surface complete and smooth, without step and artifact, justIn next step with three-dimensional stereo photo do accuracy registration merge.
CT rebuilds the registration technology of mask and three-dimensional stereo photo, use be 7 manual registration+ICP(iterativeclosestpoint, iterative closest point) automatic algorithms, two model error precision after registration merges canReach in 0.80mm, in the error range that naked eyes can be differentiated clinically. After Model registration, enter foundation height true to natureIn the software module of the thin-skinned sclerous tissues of the jaw deformation physical model of degree.
On the skeleton model of (3) rebuilding at CT, separate bone section according to fracture line or orthognathic surgery standard art formula, then reset/Displacement bone breaks to preliminary position, completes maxillofacial bone bone virtual operation.
In this step, according to conditions of patients individual difference, select suitable art formula. Fresh fracture case, comprises ifComminuted fracture, carefully differentiates fracture line and cuts apart every sclerite, then by disconnected every bone virtual reset; As be old fracture,Side separates bone section according to orthognathic surgery standard art formula, reach rescue skeleton deformity, improve occluding relation, to recover sclerotin successionalObject.
On the skeleton model of rebuilding at CT, separate bone section according to fracture line or orthognathic surgery standard art formula, then reset/movePosition bone breaks to preliminary position. This preliminary position is judged according to oneself clinical experience in the past by patient, utilizes softwareThe rotation (rotation) providing in Simulation module and translation (translation) instrument, selected bone that need to be mobileDisconnected, use mouse manual operation or set shift parameters (the XYZ axle with local coordinate system is determined orientation), complete maxillofacial bone boneVirtual operation.
In this step, according to conditions of patients individual difference, select suitable art formula. Fresh fracture case, comprises ifComminuted fracture, carefully differentiates fracture line and cuts apart every sclerite, then by disconnected every bone virtual reset, the i.e. angle of fracture siteAlign with orientation; Old fracture if, side separates bone section according to orthognathic surgery standard art formula, reach rescue skeleton deformity,Improve occluding relation, recover the successional object of sclerotin. Reset for the upper mandibular that relates to occluding relation, can utilize software to carry" boolean subtracts " Booleanoperation instrument-" INTERSECT " of confession, checks maxillomandibular contact relation and makes it to reachMaximize.
(4) CMF-preCADS software has the functional module of simulation soft tissue deformation: according to programmed algorithm and default ginsengNumber, calculate jawbone sclerous tissues and move rear corresponding soft tissue curved surface and change, and the result of variation is presented to high fidelityOn three-dimensional stereo photo;
The model of setting up in this software can be converted into the high accuracy based on three-dimensional finite element and Mass-spring model unified algorithmPhysical model, wherein programmed algorithm and default parameters relationship arrive the accuracy of simulation soft tissue deformation. Through tens of routine clinical diseasesThe precision of prediction that this software has been verified in the retrospective study of example, in 87% left and right, meets clinical demand, substantially with external simulation softwarePrecision of prediction be 90% left and right, very nearly the same. And tool particularity and novelty: at operation in patients front face 3 D stereoOn photo, show postoperative appearance, make soft tissue prediction more true to nature, have more value for clinical application.
CMF-preCADS software has the functional module of simulation soft tissue deformation: according to programmed algorithm and default parameter,Calculate jawbone sclerous tissues and move rear corresponding soft tissue curved surface variation, and the result of variation is presented to the three-dimensional of high fidelityOn stereoscopic photograph. The model of setting up in this software can be converted into based on three-dimensional finite element and Mass-spring model unified algorithmHigh accuracy physical model, its programmed algorithm is realized in following development environment: programming language (ProgrammingLanguage) adopt MicrosoftVisualStudioC++, interface instrument (Interface) uses QT, and figure is paintedInstrument processed (Graphdrawing): OpenGLphysxlibrary, deformation algorithm (Deformationalgorithm):Mass-springmodel, finiteelementmodel. Programming basic procedure for: provide based on ITK cut apart withAlgorithm for reconstructing is built geometrical model, and complete analogue system in conjunction with OpenGL and VTK under .Net platform in model canDepending on change, specific as follows:
1). utilize CT data to set up maxillofacial bone bone 3D model, utilize facial 3D stereoscopic photograph to set up facial soft tissue model;
2). be to save computer time and space, the region of deformation is concentrated on to field of operation (from the modeling of 3D stereoscopic photographMask directly extracts " intermediate mesh " model), build up a tetrahedral grid model, i.e. the non-line of two stage asymptotic expressionsProperty model; Again by analyzing the stiffness matrix (StiffnessMatrix) of two kinds of models, with to be equal to FEM model accurateProperty situation under, obtain the set-up mode of mass spring model parameter;
3). the deformation algorithm based on Finite Element Method, passes through to set physical attribute by above-mentioned grid model and skin of face modelParameter, deformation parameter and relevant parameter are realized building of facial soft tissue deformation model. Then, research Nvidia video card is carriedThe physics of confession accelerates function (PhysX) and various Joints model, utilizes up-to-date ITK/VTK kit to design and ImplementNon-linear three-dimensional finite element model, the postoperative soft tissue deformation of simulated patient.
Through the clinical verification in early stage, the precision of prediction of software is in 90% left and right. At operation in patients front face three-dimensional stereo photoThe postoperative appearance of upper demonstration, makes soft tissue prediction more true to nature, has more Clinical practicability.
(5) judge whether the soft tissue appearance after distortion reaches symmetrical and requirement attractive in appearance, repetition (3), (4) step untilReach satisfied appearance profile; This step is conducive to doctors and patients and exchanges/understand, and plays an active part in the formulation of surgical planning before operation in patients,And the rational suggestion of proposition oneself, doctor and patient is revised distance and the position that bone moves jointly, and predicts appearance profile, straightReach the effect that both sides are satisfied with, (comprise the position angle of osteotomy line, bone is disconnected need to be moved to have formulated final operation planThe distance angle parameter of moving rotation, the interior fixed configurations of preformed titanium plate etc.).
(6) threedimensional model designing is exported as to STL formatted file, then import in surgical navigational software I-plan and do artFront air navigation plan, utilizes navigator accurately to guide the disconnected intercepting of bone and displacement, realizes the operation plan of virtual design.
Navigator used is BrainLAB navigator, and guide plate material can be PLA(PLA) or synthetic resin etc.
The model designing is with the disconnected information of bone that need to be shifted, and it is combined with real-time navigation equipment can be by preoperative voidIntend planning accurately to implement in operation, obtain the soft tissue face that we finally wish; In addition, virtual plan also can be passed throughSurgical template technology is implemented, and at (4) programming phase, utilizes CAD Software for Design reset guide plate, prints guide plate entity at 3DIn art, instruct osteotomy site and displacement bone disconnected.
(7) the postoperative 3-6 month is carried out 3 D stereo shooting again to patient's face, obtains real face number after operation in patientsAccording to, utilize Geomagic software contrast verification, the similarity of preoperative forecast model and postoperative true face, similarity 95% withWhen upper, showed that preoperative prediction was accurate, wherein similarity is recently weighed with the percentage of≤2mm tri patch.
The collection of postoperative patient image data need to be identical with technology with preoperative use equipment, avoids sampling error. ForPostoperative sampling time point can not be long or too short, need to consider swelling, the hemotoncus of postoperative soft tissue, and weight in patients changes, boneThe multiple factors that affect face profile such as offset position recurrence, we advise that the sampling time is after surgery between the 3-6 month. Verification stepIn, preoperative forecast model and postoperative true model need registration analytical error, adopt equally 7 manual registration+ICP automatic algorithmsAssociating method for registering. Also can adopt the method for subjective assessment, allow patient or trained doctor to two solidsPhoto carries out the classification of similarity and judges.
Rear two steps (6), (7) are the methods of implementing operation and checking forecasting accuracy according to preoperative virtual plan, to facingMeaning and practicality that bed is implemented this soft tissue Predicting Technique have important influence.
Test one
Use the prediction emulation mode in the embodiment 1 in the present invention, test for different patients, concrete outcome is as followsTable 1:
In table 1. clinical case, the treatment effect that adopts this digitlization surgical method to obtain
From finding out above, use the prediction soft tissue appearance method in the present invention, for virtual bone plastic operation provides with reference to complying withAccording to, i.e. the operation such as the size and Orientation of preoperative clear and definite diostosis details, accomplishes that precautions averts perils; There is personalization, customization advantageNavigation and guide plate surgical technic, ensured the accurate realization of Design scheme, simultaneously operation wound is little, it is fast that patient recoversSpeed.
Test two
Use the Forecasting Methodology in embodiment 1., 20 routine old fracture of zygoma and zygomatic arch patients are predicted and diagnosis and treatment, then willThe face shape 3D model of prediction and the comparative analysis of the true appearance profile of postoperative patient, result is as table 2.
Adding up with postoperative real face profile contrast of the preoperative prediction of table 2. (mm)
Can find out from the statistical data of result: in the Ipsilateral cheekbone soft tissue area of prediction, the mean absolute error of predictionTotally reach 1.42mm, worst error is also only 3.43mm, the parameter (percentage of≤2mm) to clinical practice most worthyFor: 87.2%, also show that the macro-forecast precision of software is 87%, there is higher precision of prediction level.
Method in the present invention comprises preoperatively carries out CT scan, data importing Maxillofacial surgery is established patient's jaw faceThe meter CMF-preCADS of simulation software, rebuilding-up three-D jaw, skin surface model, reset/displacement bone break to preliminary position, utilizationThe steps such as the similarity of the preoperative forecast model of Geomagic software contrast verification and postoperative true face. Postoperative facial appearance andStomatognathic system function is all recovered well, soft tissue profile symmetry, coordination, attractive in appearance, and patient's Postoperative Satisfaction reaches more than 95%, andOrthopedic effect stability, long-term satisfaction is also very good.
Disclosed arbitrary feature in this description, unless narration especially all can or have similar object by other equivalencesAlternative features is replaced. ,, unless narration especially, each feature is an example in a series of equivalences or similar characteristics.
The foregoing is only the preferred embodiments of the present invention, is only illustrative for the purpose of the present invention, and nonrestrictive;Those of ordinary skill in the art understand, and in the spirit and scope that limit, can carry out many changing to it in the claims in the present inventionChange, amendment, even equivalence change, but all will fall within the scope of protection of the present invention.
Claims (5)
1. the computer emulation method that after prediction maxillofacial bone orthopedic, soft tissue appearance changes, comprises master and slave computer system, meterSuan Ji simulation software bag and computer operating system, master and slave computer system comprises and is positioned at the PC computer on foreground and the work on backstageStand, and with the supporting emulator of emulation, it is characterized in that, comprise the following steps:
(1) obtain data: preoperative patient's jaw face spiral CT machine is carried out to CT scan, obtain DICOM data; To patientFace carries out 3 D stereo shooting with FaceSCAN3D face three-dimensional camera shooting instrument, obtains Obj. formatted data;
(2) DICOM data and Obj. formatted data are imported to Maxillofacial surgery design and simulation software-CMF-preCADS, reconstruction of three-dimensionalJawbone, skin surface model, and merge with three-dimensional stereo photo registration, the thin-skinned sclerous tissues of jaw deformation physical model set up, threeDimension finite element and Mass-spring model association, the linear elasticity Deformation Law of simulation of facial skin;
(3) on the three-dimensional jawbone model of the foundation in step (2), cut apart the fracture site of displacement or by orthognathic surgery standard artFormula separates bone section, and reset or displacement bone break to a preliminary position;
(4) calculate jawbone sclerous tissues with software again and move rear corresponding soft tissue curved surface variation;
(5) doctor and patient jointly measure and determine distortion after soft tissue appearance;
(6) the reconstruction of three-dimensional model behind bone offset position is saved as to STL formatted file, then import operation guiding system BrainLABIn the subsidiary software I-plan of institute, do preoperative air navigation plan, in art, instruct the accurate enforcement of virtual plan;
(7) the postoperative 3-6 month is carried out 3 D stereo shooting again to patient's face, obtains real face data after operation in patients, profitBy Geomagic software contrast verification, the similarity of preoperative forecast model and postoperative true face, similarity is at 95% above time tableBright preoperative prediction is accurate, and wherein similarity is recently weighed with the percentage of≤2mm tri patch.
2. the computer emulation method changing according to the rear soft tissue appearance of prediction decorative sursery operation described in claim 1,It is characterized in that: in described step (1) CT scan scope be margo supraorbitalis to hyoid bone level, resolution ratio is 512 × 512, bed thickness≤0.9mm, scanning voltage and electric current are respectively 140kV and 220mAs.
3. the computer emulation method changing according to the rear soft tissue appearance of prediction decorative sursery operation described in claim 1,It is characterized in that: in described step (4), calculate jawbone sclerous tissues with software and move rear corresponding soft tissue curved surface variation, and willThe result changing shows with facial three-dimensional stereo photo.
4. the computer emulation method changing according to the rear soft tissue appearance of prediction decorative sursery operation described in claim 3,It is characterized in that: after first utilizing facial finite element deformation physical model prediction jawbone Slide in described step (4), soft tissue holdsLooks change, and calculate jawbone sclerous tissues with software and move rear corresponding soft tissue curved surface variation, and by face for the result changingThree-dimensional stereo photo shows.
5. the computer emulation method changing according to the rear soft tissue appearance of prediction decorative sursery operation described in claim 1,It is characterized in that: in described step (5), doctor and patient is common measures and determines and the soft tissue appearance after distortion repeat (3) (4)Step is until doctor and patient is consistent.
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