数字化及3D打印技术结合非血管化髂骨修复外伤性上颌骨前牙区骨缺损的疗效  

Effect of digital and 3D printing technology combined with non-vascularized ilium in repairing post-traumatic bone defect in maxillary anterior teeth area

作　　者：高宁[1] 付坤[1] 张瑞璞 陈浩[1] 许曼君 何巍[1] Gao Ning;Fu Kun;Zhang Ruipu;Chen Hao;Xu Manjun;He Wei(Department of Oral and Maxillofacial Surgery,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院口腔颌面外科,450052

出　　处：《中华创伤杂志》2021年第2期136-140,共5页Chinese Journal of Trauma

摘　　要：目的探讨数字化及3D打印技术结合非血管化髂骨修复外伤性上颌骨前牙区骨缺损的疗效。方法采用回顾性病例系列研究分析2013年6月至2018年1月郑州大学第一附属医院收治的8例外伤性上颌骨前牙区严重骨缺损患者临床资料,其中男6例,女2例;年龄18〜43岁[(31.9±9.0)岁]。术前均采用数字化技术对上颌骨进行重建,根据缺损区需要恢复的最佳形态确定截取髂骨的范围,利用31)打印技术打印出头模及导板,在头模上进行钛网的预弯制,术中根据导板进行取骨和Onlay植骨。术后6〜9个月进行种植修复,4〜6个月后行烤瓷冠修复。观察植骨术后6个月髂骨成活情况及术后并发症情况,种植体植入前测量牙槽睹近远中、垂直向及唇腭侧的骨量提升高度,烤瓷冠修复6个月后观察种植体周围情况,采用视觉模拟评分(VAS)对髂骨移植后、种植体植入后疼痛进行评估,手术当天及术后4个月采用种植体稳定系数(ISQ)评估种植体稳定性。结果患者均获随访24-48个月[(33.3±9.7)个月]。8例非血管化髂骨全部成活。植骨后轻度感染1例,种植体植入后出现牙龈炎性增生1例,经治疗愈合良好。未见明显种植体周围炎,移植骨未见明显吸收。缺牙区牙槽嵴近远中骨量提升为30.28-39.67mm,垂直向骨量提升为9.58-11.32mm,唇腭向骨量提升为2.06〜7.41mm.种植体均形成了良好的骨结合。种植体植入后VAS为(3.4±0.7)分,较髂骨移植后的(7.3±2.0)分明显降低(P<0.05).术后4个月的ISQ(84.4±1.9)与手术当天(72.9±1.4)比较,差异无统计学意义(P>0.05).结论应用数字化及3D打印技术结合非血管化髂骨修复外伤性上颌骨前牙区严重骨缺损,可提高移植骨成活率;术后给予种植修复,可减轻疼痛,能够较好地恢复患者面部外观,获得满意的口腔生理功能。Objective To explore the effect of digital technology and 3D printing technology combined with non-vascularized ilium bone in repairing post-traumatic bone defect in maxillary anterior area.Methods A retrospective case series study was performed to analyze clinical data of 8 patients with severe hone defect in maxillary anterior area after trauma admitted to First Affiliated Hospital of Zhengzhou University from June 2013 to Januaiy 2018.There were 6 males and 2 females,with the age of 1843 years[(31.9±9.0)years].The maxillary bone was reconstructed before surgery by employing digital technology.The intercept range of ilium was detennined according to the best fomi of defect to be recovered.Then the model and guide plate was printed out by employing 3D print technology.The titanium mesh was prebended on the model.The bone was extracted and Onlay bone grafting was performed according to the guide plate.The implant restoration was performed 6 to 9 months after operation,and porcelain crown restoration was performed 4 to 6 months later.The iliac bone survival and postoperative complications were detected 6 months after bone grafting.The near-middle-far and vertical bone elevation of the alveolar ridge as well as bone elevation of lip palatal were measured before implantation.The condition around the implants was observed 6 months after porcelain crown restoration.The visual analogue score(VAS)was used to evaluate the pain after iliac bone transplantation and implantation.The implant stability coefficient(ISQ)was applied to assess the stability of the implants on the day and 4 months after operation.Results All the patients were followed up for 2448 months[(33.3±9.7)m on ths].Eight patients with non-vascularized iliums were all survived.There was one patient with mild infection after bone grafting and one patient with gingival inflammatory hyperplasia after implantation,both of whom were healed after treatment.There was no obvious peri-implant inflammation or absorption of the grafted bone.The increase in height of

关 键 词：上颌骨骨折 髂骨 牙种植 数字化技术 

分 类 号：R782.4[医药卫生—口腔医学]