混合现实联合3D打印技术在全面部骨折手术中应用价值  

Role of mixed reality combined with 3Dprinting technology in panfacial fractures surgery

作　　者：吕继连 张瑞 赵媛 林楠 王鹏 连鸿凯 LYU Ji-lian;ZHANG Rui;ZHAO Yuan;LIN Nan;WANG Peng;LIAN Hong-kai(Department of Oral and Maxillofacial Surgery,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou,Henan 450007,China;Department of Orthopedics,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou,Henan 450007,China)

机构地区：[1]郑州大学附属郑州中心医院口腔颌面外科,河南郑州450007 [2]郑州大学附属郑州中心医院骨科,河南郑州450007

出　　处：《中华实用诊断与治疗杂志》2022年第12期1273-1276,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省科技攻关计划(182102311118);河南省医学教育研究项目(Wjlx2021418)。

摘　　要：目的探讨全面部骨折患者采用混合现实(mixed reality,MR)联合3D打印技术进行术前个体化颌面部复位设计及指导术中精准操作的效果。方法40例行手术治疗的全面部骨折患者随机分为观察组和对照组各20例,术前均行颅颌面部64排CT检查,采集颌面部各部分骨骼硬组织三维影像数据。对照组根据CT数据行传统经典颌面坚强内固定手术治疗;观察组应用医学图像处理软件分析CT数据,分割各骨折块建立三维数字模型,匹配正常成人颅颌面骨后按照解剖位置虚拟复位,应用MR眼镜预演MR复位手术过程及术后效果;采用3D打印技术打印复位前、后颅颌面骨模型,根据骨折线分布情况预弯制钛板;术中在MR引导下验证复位精度并及时修正,校准骨折块复位位置与虚拟复位位置一致后行钛板钛钉坚强内固定。比较2组术中出血量、手术时间、住院时间。术后随访12个月,观察2组创面愈合情况及面神经损伤、眶下神经损伤、复视、眼球内陷等并发症发生情况,记录术后3个月时2组张口度、咬合关系、面型满意度,行颅颌面部CT评估钛板固定情况。结果观察组手术时间[(6.57±1.04)h]、住院时间[(16.05±1.23)d]均短于对照组[(8.45±0.70)h、(19.15±1.69)d](t=6.719,P<0.001;t=6.613,P<0.001),术中出血量[(63.00±7.06)mL]少于对照组[(94.50±8.82)mL](t=12.464,P<0.001)。术后3个月时观察组张口度[(39.09±0.64)mm]大于对照组[(36.26±0.61)mm](t=-9.529,P<0.001),咬合稳定、面型满意比率(95.0%、95.0%)均高于对照组(65.0%、70.0%)(χ^(2)=5.625,P=0.018;χ^(2)=4.329,P=0.037);2组术后随访期间创面1期愈合良好,无感染及钛板排斥反应,无面神经或眶下神经损伤、复视、眼球内陷等并发症,均未出现钛板松动移位或感染情况。结论MR联合3D打印技术可个体化精准设计全面部骨折患者手术方案,术中实时验证复位精度,缩短手术时间和住院时间,减少术中出血量,有助�Objective To explore the effect of mixed reality(MR)combined with 3Dprinting technology on the preoperative individualized maxillofacial reduction design,and guidance in precise operation of panfacial fracture(PFF).Methods Forty PFF patients were randomly and equally divided into observation group and control group,and received maxillofacial 64-slice CT scan to collect the 3Dimage data of maxillofacial bone before surgery.Control group was performed traditional rigid internal fixation.In observation group,CT data were analyzed by medical image software,three-dimensional digital model was established by separating each facture bone,virtual reduction was performed according to the anatomical position after matching normal adult craniofacial bone,and the process of MR reduction and the postoperative effect were viewed with MR glasses.The anterior and posterior craniofacial bone models were printed by 3Dprinting,and the titanium plates were pre-bent according to the fracture lines.The reduction accuracy was verified and corrected in time under MR guidance,and the titanium plate and titanium nail were used for rigid internal fixation after the reduction position of the fracture block was calibrated to be consistent with the virtual reduction position during the operation.The intraoperative blood loss,operation lasting time and length of hospital stay were compared between two groups.All patients were followed up for 12months to observe the wound healing and complications such as facial nerve injury,infraorbital nerve injury,diplopia and enophthalmos in two groups.The opening degree,occlusal stability and facial satisfaction degree were recorded 3months after surgery in two groups.The titanium plate fixation was examined by craniomaxillofacial CT examination.Results The operation time and length of hospital stay were shorter in observation group[(6.57±1.04)h,(16.05±1.23)d]than those in control group[(8.45±0.70)h,(19.15±1.69)d](t=6.719,P<0.001;t=6.613,P<0.001),and the intraoperative blood loss was less in observatio

关 键 词：全面部骨折 混合现实 3D打印 

分 类 号：R687.3[医药卫生—骨科学]