摘要
目的探讨三维打印导板在口腔颌面外科中的临床应用并对其设计及应用进行优化和规范。方法回顾性分析2010年1月至2020年12月于解放军总医院口腔颌面外科进行手术的患者资料,包括40例下颌骨肿瘤手术患者(常规组20例、导板组20例)、20例颞下颌关节置换手术患者(常规组10例、导板组10例)、20例正颌双颌手术患者(常规组10例、导板组10例)、20例放射粒子植入手术患者(常规组10例、导板组10例);患者中位年龄45岁(16~75岁),其中男性58例,女性42例。所有导板组患者术前均进行螺旋CT扫描并建立颌骨及供骨区三维模型(上颌骨和下颌骨模型各40个)以模拟手术,计算机辅助设计手术导板(包括截骨及定位成形导板共40套、穿刺定位导板10个)。分析模型打印时间以及各导板的设计时间、打印时间、导板应用对手术时间及手术精度的影响。结果下颌骨肿瘤手术、颞下颌关节置换手术、正颌双颌手术、放射粒子植入手术的手术导板设计时间分别为(2.8±1.8)、(2.2±0.3)、(2.9±1.8)和(0.9±0.3)d。上颌骨模型和下颌骨模型打印时间为(11.1±1.6)和(2.6±0.4)h,截骨及定位成形导板打印时间为(2.5±0.8)h,穿刺定位导板打印时间为(1.1±0.4)h。下颌骨肿瘤手术及放射粒子植入手术导板组手术时间[分别为(6.02±0.55)和(0.89±0.15)h]均显著少于相应常规组[分别为(6.99±1.10)和(1.91±0.55)h](P<0.05),正颌双颌手术及颞下颌关节置换手术导板组手术时间与相应常规组差异均无统计学意义(P>0.05)。下颌骨肿瘤手术及颞下颌关节置换手术导板组标志点位移距离均显著小于相应常规组(P<0.05),正颌双颌手术及放射粒子植入手术导板的误差基本在1 mm以内。结论口腔颌面外科手术三维打印系列导板的应用有助于精准、快捷地完成手术,但其设计、制作等环节仍需进一步规范和改进。
Objective To explore the application of three-dimensional(3D)printing technology in oral and maxillofacial surgery,so as to optimize and standardize its design and application.Methods From January 2010 to December 2020,40 cases of mandibular tumor surgery(20 cases of conventional group and 20 cases of guide plate group),20 cases of temporomandibular joint replacement surgery(10 cases of conventional group and 10 cases of guide plate group),20 cases of malocclusion surgery(10 cases of conventional group and 10 cases of guide plate group),20 cases of radioactive particle implantation surgery(10 cases of CT guided group and 10 cases of guide plate group)were analyzed.All patients in the guide plate group were scanned with spiral CT,and the 3D models of the jaw and the donor bone area were reconstruction.According to the purpose of surgical guide,the design and clinical application of osteotomy guide,in place forming guide and puncture positioning guide were analyzed respectively.The design time of guide plate,the performance and printing time of guide material,the sterilization method of guide and its influence on accuracy,and the influence of guide application on operation time and accuracy were analyzed.Results The design time of orthognathic guide plate was(2.9±1.8)d,and the design time of mandibular transplantation guide plate was(2.8±1.8)d,that of the temporomandibular joint replacement guide plate and the puncture guide plate was(2.2±0.3)and(0.9±0.3)d.The average printing time of the 40 maxilla model was(11.1±1.6)h,and that of the 40 mandible models was(2.6±0.4)h.The average printing time of the 40 sets of osteotomy and positioning guide plate was(2.5±0.8)h,and that of the 10 puncture positioning guide plate(1.1±0.4)h.The operation time of the conventional group was(6.99±1.10)and(6.02±0.55)h.In the CT guided group,the operation time was(1.91±0.55)h and(0.89±0.15).The operation time of mandible tumor operation and radioactive particle implantation in the guide plate group was less than that in the control group(P<0.05),and there was no significant difference in the operation time of orthognathic surgery and joint replacement between the two groups(P>0.05).The displacement distance of the mark points in the TMJ replacement and mandibular tumor operation guide group was less than that in the control group(P<0.05),and the error of the guide plate in orthognathic operation and particle implantation operation was basically less than 1 mm.Conclusions The application of the surgical guide plate made by 3D printing technology helps to complete the operation more safely,accurately and quickly,But its design,manufacture and disinfection still need to be further standardized and improved.
作者
刘华蔚
李永锋
母晓丹
相磊
谭新颖
胡敏
Liu Huawei;Li Yongfeng;Mu Xiaodan;Xiang Lei;Tan Xinying;Hu min(Department of Oral and Maxillofacial Surgery,General Hospital of Chinese PLA,Beijing 100853,China;Department of Stomatology,The Fourth Medical Center of PLA General Hospital,Beijing 100142,China)
出处
《中华口腔医学杂志》
CAS
CSCD
北大核心
2021年第11期1085-1091,共7页
Chinese Journal of Stomatology
基金
国家重点研发计划(2017YFB1104103)
北京市科学技术委员会科技计划(D131100003013001)
解放军总医院青年扶持项目(QNF19017)。
关键词
计算机辅助设计
口腔外科手术
夹板
体层摄影术
螺旋计算机
成像
三维
三维打印
Computer-aided design
Oral surgical procedures
Splints
Tomography,spiral computed
Imaging,three-dimensional
Three-dimensional printing
