3D打印下颌骨定位及连接导板在下颌骨缺损修复中的应用  

Application of mandibular positioning and connecting guided by three-dimensional printing technique in mandibular reconstruction

作　　者：徐波[1] 冉红兵[1] 林川[1] 杨丽俊[1] 李文[1] 陈尧 XU Bo;RAN Hongbing;LIN Chuan;YANG Lijun;LI Wen;CHEN Yao(Department of Stomatology,Panzhihua Central Hospital,Panzhihua 617000,China)

机构地区：[1]四川省攀枝花市中心医院口腔科,四川攀枝花617000 [2]攀枝花学院数学与计算机学院数据分析与大数据专业教研室,四川攀枝花617000

出　　处：《口腔医学》2020年第8期731-737,共7页Stomatology

基　　金：四川省卫健委科研课题普及应用项目(18PJ098)。

摘　　要：目的探讨下颌骨定位及连接导板在下颌骨缺损修复中的临床应用意义。方法纳入6例需要进行下颌骨缺损修复的患者,使用3D打印技术设计和制作个体化的下颌骨定位及连接导板,用于术中指导下颌骨缺损的修复,术后采集三维CT影像数据与术前进行比较,建立个体化三维坐标系,测量下颌骨相关解剖标志点的三维坐标数据,分析术后髁突位移情况,结合术后临床随访,以评价其临床应用价值。结果术后随访,所有患者均面部外观对称,外形恢复满意,张口度、张口型及余留牙咬合关系正常,无颞下颌关节症状,相关解剖标志点在各个三维方向上的位移绝对值均值最大为1.08 mm,是右侧下颌骨喙突在左右方向的位移,标准差最大为0.82,标准误最大为0.33。术后髁状突的位移被控制在了临床可接受的范围内。结论下颌骨定位及连接导板能有效减少下颌骨截断后的位移影响,保留重建下颌骨的原有空间位置,使术后髁状突的位置恢复到自然状态,极大地提高了下颌骨修复重建的精确性和美观性。Objective To investigate the clinical application significance of mandibular positioning template and connecting template manufactured by three-dimensional printing technique in mandibular reconstruction.Methods Six patients requiring a mandibular reconstruction were included in the study.The mandible was reconstructed and guided by the positioning template and connecting template,which were manufactured by three-dimensional printing technique before surgery.The patient's CT data were collected for 3D image reconstruction to establish an individualized three-dimensional coordinate system,and the preoperative and postoperative three-dimensional coordinate data of the relevant mandibular landmarks were measured for comparison to analyze the condylar displacement.All the patients were followed up regularly to evaluate its clinical application value.Results After the follow-up,all patients had satisfactory facial appearance,normal mouth opening,correct functional occlusal relations,and no TMJ symptoms were observed.In each three-dimensional direction,the maximum mean value of displacement was 1.08 mm,which was the movement of the right mandibular condyle in the left-right direction.The maximum standard deviation was 0.82,and the maximum standard error was 0.33,which was clinically acceptable.Conclusion Mandibular positioning template and connecting template can restore the correct spatial position of the condyles and preserve the original dimensions of the reconstructed mandible,which makes the condyle return to normal state,and greatly improves the accuracy and aesthetics of mandibular reconstruction.

关 键 词：3D打印技术 下颌骨缺损修复 外科手术 导板 

分 类 号：R782.4[医药卫生—口腔医学]