Päijät-Häme Joint Authority for Health and Wellbeing, Department of Oral and Maxillofacial Surgery, Lahti, Finland.
Cleft Palate and Craniofacial Centre, Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Oral and Maxillofacial Diseases, Head and Neck Center, University of Helsinki and Helsinki University Hospital, Finland.
J Craniomaxillofac Surg. 2024 Jan;52(1):93-100. doi: 10.1016/j.jcms.2023.11.010. Epub 2023 Dec 4.
The aim of the study was to compare the stability of the virtual surgical planning (VSP) and computer-aided design accompanied by patient-specific implants (PSIs) and conventional mini-plates in mandible advancement with bilateral sagittal split osteotomy (BSSO). This retrospective study evaluates the clinical and cephalometric records of 53 patients (12 male, 41 female) treated with BSSO in Helsinki University Hospital. Subjects were divided into two groups: VSP-PSI (21 patients: 4 male and 17 female; mean age 38 years, range 25-53 years); and conventional wafer-based repositioning with mini-plate fixation (32 patients: 8 male and 24 female; mean age 39 years, range 21-56 years). The effect of the amount and direction of the advancement on the stability was also analysed individually. The standardized lateral cephalometric radiographs in three time points were analysed to compare the groups. After surgery (T2), there were no differences between groups in cephalometric variables. During follow-up (T2-T3), the cephalometric variables in both Groups A and B were stable, so there was no difference in stability between the VSP-PSI and the conventional mini-plate groups. During follow-up, the mandibles rotated clockwise or counterclockwise, relapsed towards their original direction, and the changes were statistically significant (jaw relationship; p = 0.018, soft tissue profile; p = 0.025); when the advancement of mandible was >6 mm, the increase in gonial angle compared to mandibles advanced ≤6 mm was statistically significant (p = 0.03). VSP-PSI and conventional mini-plate fixation can be considered equally stable. Large advancements with counterclockwise rotation regardless of fixation method are more susceptible to relapse. VSP-PSI alone cannot solve the relapse-related concerns in mandible osteotomy.
本研究旨在比较虚拟手术规划（VSP）和计算机辅助设计伴患者特异性植入物（PSI）与双侧矢状劈开截骨术（BSSO）治疗下颌前突的稳定性。本回顾性研究评估了赫尔辛基大学医院 53 例接受 BSSO 治疗的患者（12 名男性，41 名女性）的临床和头影测量记录。受试者分为两组：VSP-PSI 组（21 例：4 名男性和 17 名女性；平均年龄 38 岁，范围 25-53 岁）；和常规基于晶圆的重新定位伴 mini 板固定组（32 例：8 名男性和 24 名女性；平均年龄 39 岁，范围 21-56 岁）。还单独分析了推进的数量和方向对稳定性的影响。在三个时间点比较了两组的标准化侧位头颅侧位片。术后（T2），两组的头影测量变量无差异。随访期间（T2-T3），两组的头影测量变量均稳定，因此 VSP-PSI 组和常规 mini 板组之间的稳定性无差异。随访期间，下颌骨顺时针或逆时针旋转，向原始方向复发，变化具有统计学意义（颌关系；p=0.018，软组织轮廓；p=0.025）；当下颌骨前突>6mm 时，与前突≤6mm 的下颌骨相比，下颌角增加具有统计学意义（p=0.03）。VSP-PSI 和常规 mini 板固定可认为同样稳定。无论固定方法如何，逆时针旋转的大前突更容易复发。单独的 VSP-PSI 并不能解决下颌骨截骨术相关的复发问题。
