應用於下顎骨重建手術之腓骨分段及鋸切導引

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姓名

謝正一(Cheng-yi Hsieh) 查詢紙本館藏

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機械工程學系

論文名稱

應用於下顎骨重建手術之腓骨分段及鋸切導引

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摘要(中)

下顎骨因為外傷、癌症等情況下，需要切除部分下顎骨，所造成的缺陷必須接受重建手術，以期恢復臉部外型輪廓和咀嚼功能，目前醫學界常使用腓骨游離皮瓣重建。以腓骨重建下顎骨所面臨的困難之處是如何量測下顎骨的缺損範圍、如何決定並鋸切腓骨的拼接面角度，及如何以分段式的腓骨建構理想下顎骨外型，使手術結果能兼具美觀與功能。
本研究以長方體紙模型與輔助器械協助決定腓骨皮瓣片段長度及鋸切腓骨、並提出腓骨片段數量的決策演算法等。方法是利用建構的下顎骨模型投影至二維平面取得下顎骨輪廓，以此輪廓規劃下顎骨缺損範圍，再應用演算法求得腓骨片段數量與腓骨拼接間所需的切割角度、長度，並據以製作簡易的長方體紙模型，提供輔助機構組合成下顎骨缺損所需的腓骨片段，作為鋸切腓骨的依據，以完成下顎骨重建。
以長方體紙模型協助重建方法已應用在臨床上，共六案例且皆成功。另外結合腓骨片段數量決策演算法與腓骨皮瓣鋸切用輔助器械，用於下顎骨模型的重建實驗中，可準確且迅速測量下顎骨缺損，切割出理想的腓骨接觸切面，並測得腓骨片段的切面貼合間隙於1.1mm範圍內。

摘要(英)

For patients with mandibular defects caused by tumor resection or trauma, they usually need to receive mandibular reconstruction to restore facial profile and chewing function. The common approach is to use free fibula flap for filling in mandibular defect. The difficulties of mandibular reconstruction come from the measurement of the defect size, the determination of the bevel surface orientation of each fibula bone segment, and the osteotomy of fibula bone.
In this research, we developed a new method for mandibular reconstruction, which used a rectangular paper model for presurgical planning, an assistive mechanical device for guiding osteotomies, and an decision algorithm for deciding the number of bone segments. The approach is to project a reconstructed 3D mandible model from CT images to obtain a planar outline of the mandible for estimating the mandible defect size. Then use the decision algorithm to determine the number of fibular segments and the angles of beveling surfaces of each fibula segment. Based on the calculated results, a paper model is produced for adjusting the assistive devices to form the required shape and number of fibula bone segments. The assistive devices are then used as the guidance for fibula bone osteotomy.
The paper model method for assisting mandibular reconstruction had been applied to clinical trials. All of the six cases were successful. Furthermore, combining the fibula segment decision-making algorithm and the assistive device for reconstructing the defect of a saw bone mandible model is also successful. The gap between the surfaces of two neighboring fibula bone segments was less than 1.1mm.

關鍵字(中)

★ 下顎骨
★ 下顎骨重建
★ 腓骨游離皮瓣

關鍵字(英)

★ Mandible
★ Mandible Reconstruction
★ Free fibula flap

論文目次

摘要 I
Abstract II
誌謝 III
目錄 IV
圖目錄 VII
表目錄 XII
第1章緒論 1
1-1 研究動機與目的 1
1-2 文獻回顧 4
1-2-1 文獻回顧之綜合結論 9
1-3 研究方法簡介 10
1-4 章節概敘 11
第2章以長方體紙模型協助下顎骨重建 12
2-1 重建三維下顎骨模型 12
2-1-1 三維模型重建之介紹 12
2-1-2 三維模型重建之雜訊 13
2-1-3 下顎骨區分部位名稱 14
2-2 長方體模擬下顎骨之定義 14
2-2-1 長方體之設計 17
2-2-2 長方形體之腓骨間接觸面 18
2-2-3 長方體之限制 19
2-3 長方體紙模型重建下顎骨之應用 19
2-3-1 長方形體紙模型之應用方式 21
2-3-2 長方體紙模型之腓骨裁切 22
2-4 下顎骨重建實際應用長方體紙模型之結果 24
2-4-1 結果評估 27
第3章腓骨皮瓣鋸切用輔助器械 29
3-1 輔助器械架構 29
3-1-1 輔助器械之設計 29
3-1-2 輔助器械之各部位介紹 31
3-1-3 輔助器械之自由度 33
3-1-4 輔助器械之多組配合 34
3-1-5 下顎骨重建之理想外觀 34
3-2 輔助器械之應用 35
3-2-1 輔助器械之實驗 35
3-2-2 實驗結果與討論 40
3-3 結合輔助器械與長方體紙模型輔助下顎骨重建 42
3-3-1 實驗進行 42
3-3-2 實驗結果與討論 44
第4章腓骨片段數量決策演算法 47
4-1 腓骨片段數量決策演算法之介紹 47
4-2 下顎骨輪廓 49
4-3 決定下顎骨缺損範圍 50
4-4 腓骨片段數量決策方式 51
4-4-1 20mm~40mm缺損範圍 53
4-4-2 40mm~60mm缺損範圍 54
4-4-3 超過60mm的缺損範圍 56
4-5 腓骨片段演算法之應用 58
4-5-1 模擬實驗 60
4-5-2 重建實驗 66
4-5-3 應用結果 75
第5章結論與未來展望 76
5-1 結論 76
5-2 未來展望 77
文獻回顧 79

參考文獻

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指導教授

曾清秀(Ching-Shiow Teseng)

審核日期

2009-8-3

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