三维打印个性化修复体修复颧眶-上颌复合体骨缺损初探  

Reconstruction of zygomatico-orbtial and maxillary bone defects using three-dimensional printed customized prosthesis

作　　者：李永锋[1] 刘华蔚[1] 王超[2] 席庆[1] 张明[1] 胡敏[1] Li Yongfeng;Liu Huawei;Wang Chao;Xi Qing;Zhang Ming;Hu Min(Department of Oral and Maxillofacial Surgery,General Hospital of Chinese PLA,Beijing 100853,China;Beijing Advanced Innovation Center for Biomedical Engineering,Beihang University,Beijing 100083,China)

机构地区：[1]解放军总医院口腔颌面外科,北京100853 [2]北京航空航天大学生物医学工程高精尖创新中心,100083

出　　处：《中华口腔医学杂志》2021年第7期633-638,共6页Chinese Journal of Stomatology

基　　金：国家重点研发计划(2017YFB1104100);北京市科学技术委员会科技计划(D131100003013001)。

摘　　要：目的借助三维打印技术制作个性化修复体对颧眶-上颌复合体骨缺损患者进行修复重建,为临床颌面部复杂骨缺损修复提供参考。方法前瞻性选择2019年4月至2020年12月于解放军总医院口腔颌面外科就诊的颧眶-上颌复合体骨缺损患者5例,其中男性3例,女性2例,年龄28~53岁。计算机辅助设计两种个性化修复体(以颞骨、鼻骨及颧额为固定端),两种修复体其他部位设计相同,仅眶底延伸部分长度不一致;设计一:由眶下缘向眶内延伸9~10 mm;设计二:由眶下缘向眶内延伸10~15 mm。采用钛合金粉末三维打印两种修复体。获取两种修复体实物的三维扫描数据,在UG12.0软件中拟合,分析两种修复体的匹配度。术中对两种修复体对颧眶-上颌复合体骨缺损的修复重建效果进行对比评估,并根据修复体适配情况选择植入。结果三维打印制备的修复体可有效进行颧眶-上颌复合体骨缺损的修复重建,术中验证显示,两种修复体固定端偏移误差为2~3 mm;软件拟合结果显示,两种修复体固定端误差范围约为1 mm。对5例患者均选择设计一修复体进行植入,术后即刻患者面部外形得到有效恢复。结论三维打印个性化修复体修复颧眶-上颌复合体骨缺损效果良好,但针对多突起复杂结构的设计和制备,需考虑多种因素对最终修复体效果的影响。Objective To reconstruct zygomatico-orbtial and maxillary bone defects using three-dimensional(3D)printing technology,so as to provide the basis for complicated maxillofacial bone defects.Methods Five patients diagnosed with in zygomatico-orbtial and maxillary neoplasm in Department of Oral and Maxillofacial Surgery,General Hospital of Chinese PLA,who need bone defect reconstruction after surgery.Two different customized prosthesis were fabricated by computer aided design and 3D printing techonology,and the length of orbital floor extension in the customized prosthesis were different:Design 1,9-10 mm orbital floor extension;Design 2,10-15 mm orbital floor extension.The clinical outcome were evaluated during operation and matching condition of two different designed prosthesis were carried out after scanning for analysis.Results The results indicated that the deviation value were 2-3 mm located at fixed structure during clinical evaluaton,and the deviation value were about 1 mm after prosthesis scanning.Finally,prothesis of Design 1 were applied for clinical use,and satisfactory reconstruction contour was achieved in all patients.Conclusions The results suggest that zygomatico-orbtial and maxillary bone defects reconstruction can be conducted with satisfactory effect using 3D printing technology,and design and fabrication factors should be taken into consideration in complicated structure design with multi-protuberance.

关 键 词：骨重建 颌面假体 颧骨 眼眶 上颌骨 三维打印 

分 类 号：R318[医药卫生—生物医学工程] R782.2[医药卫生—基础医学]