虚拟手术计划及3D打印导板辅助在游离腓骨瓣精准重建下颌骨中的价值分析  

Virtual planning and 3D printing modeling for mandibular reconstruction with fibula free flap

作　　者：任文豪[1] 高岭[1] 李少明[1] 李凡[2] 郅远 宋建忠[1] 王启博 薛令法[1] 屈志刚 郅克谦[1] Ren Wenhao;Gao Ling;Li Shaoming;Li Fan;Zhi Yuan;Song Jianzhong;Wang Qibo;Xue Lingfa;Qu Zhigang;Zhi Keqian(Department of Oral and Maxillofacial Surgery,the Affiliated Hospital of Qingdao University,Qingdao 255666,China)

机构地区：[1]青岛大学附属医院口腔颌面外科,青岛255666 [2]青岛大学附属医院种植科,青岛255666 [3]青岛大学附属医院手足外科,青岛255666 [4]中南大学湘雅口腔医学院

出　　处：《中华医学杂志》2018年第33期2666-2670,共5页National Medical Journal of China

基　　金：中国博士后科学基金（2017M622145,2017M612217）;山东省自然科学基金（ZR2018BH021）;青岛市博士后基金;青岛市源头创新计划（18-2-2-77-jch）

摘　　要：目的评价术前虚拟手术计划及3D打印导板辅助下游离腓骨瓣重建下颌骨及腓骨种植修复的效果。方法选取2013年6月至2017年6月于青岛大学附属医院口腔颌面外科行腓骨瓣重建下颌骨病例18例，男11例、女7例，年龄21～73岁，平均年龄36．5岁。均为下颌骨良眭肿瘤，其中采用术前虚拟手术设计，术中应用3D打印导板辅助，预弯钛板，切除下颌骨及腓骨，腓骨塑形，患者9例，不借助上述技术9例，两组缺损部位及范围类似。比较两组手术时间，并对比分析。选取下颌角，髁状突，颏点作为参考点，测量双侧髁状突距离，双侧下颌角距离，前后距离，对比两组术前术后差异。结果采用虚拟手术设计及3D打印导板技术组手术平均时问为4．7～6．2（5．5±0．5）h，未采用组手术平均时间为5．6—7．5（6．6±0．7）h。采用虚拟手术设计及3D打印导板组差异与传统组双侧髁状突距离，双侧下颌角距离，前后距离，术前术后两组分别为（2．6±1．4）比（4．4±1．6）mm，（2．9±1．2）比（4．7±1．7）mm，（4．2±1．4）比（5．9±1．8）／／IlTI，差异均有统计学意义（均P〈0．05）。结论术前虚拟手术设计及3D打印导板辅助手术可有效缩短腓骨瓣重建下颌骨的时间，提高重建的精确性，种植体植入及修复的效果良好，值得推广应用。Objective To evaluate the use of virtual planning and 3D printing modeling in mandibular reconstruction and compare the operation time and surgical outcome of this technique with conventional method. Methods Between June 2013 and June 201＂7, A total of 18 patients underwent the mandibular reconstruction with fibula free flap in the Affiliated Hospital of Qingdao University. Among 18 patients, there were 11 males and 7 females with an average age of 36. 5 years （21 -73 years）. Nine patients underwent vascularized fibula flap mandibular reconstruction using virtual planning and 3D printing modeling. Titanium plates were pre-bent using the models and cutting guides which were used for osteotomies. Another 9 patients who underwent mandibular reconstruction using fibula flap without aid of virtual planning and 3D printing models were selected as control group. The operation time was recorded and compared in two groups. Accuracy of reconstruction was measured by superimposing the preoperative image onto the postoperative image of mandible. The selected bony landmark, distance and angle were measured. Results The mean total operation time were 4. 7 - 6. 2 （5.5 -＋ 0. 5 ） h in computer-assisted group and 5.6 - 7.5 （6. 6 ＋ 0. 7 ） h in conventional group, respectively. The operation time was shorter in computer-assisted group. The difference between the preoperative and postoperative intercondylar distances, intergonial angle distances, anteroposterior distances were （2. 6 ＋ 1.4 ） vs （4. 4 _＋ 1.6 ） ram, （ 2. 9 ＋ 1.2 ） vs （4. 7 -＋ 1.7 ） mm, （4. 2 -＋ 1.4） vs （5.9 ＋ 1.8） mm in the computer-assisted and conventional group, respectively. The differences between the preoperative and postoperative mandible were smaller in the computer-assisted group.Conclusions Virtual planning and 3D printing modeling have the potential to increase mandibular reconstruction accuracy and reduce operation time. We believe that this technology for mandibular reconstruction in selected patients ca

关 键 词：下颌骨 修复外科手术 虚拟手术设计 3D打印 

分 类 号：R782.4[医药卫生—口腔医学]