预成钛网联合自体髂骨及松质骨游离移植二期修复单侧下颌骨缺损

Secondary reconstruction of unilateral mandible defect using CAD/CAM-prefabricated titanium mesh combined with autogenous iliac cancellous bone grafts

目的探讨已形成下颌偏斜、咬合错乱的单侧下颌骨缺损二期修复的有效方法。方法对单侧下颌骨部分切除造成下颌偏斜和咬合错乱的9例患者行术前CT扫描,计算机辅助设计与制作(CAD/CAM)快速原型技术重建颅颌面骨三维数字模型,并以健侧下颌骨为模板,镜像形成缺损侧下颌骨。激光树脂成型机打印下颌骨实体模型,在实体模型上按缺损范围设计钛网,使预成钛网与缺损下颌骨外形一致。数控成型机制备钛网,切取髂骨及其松质骨,联合预成钛网植入完成下颌骨缺损二期修复。结果预成钛网联合9例髂骨松质骨移植均获成功,创口愈合良好,下颌骨外形恢复满意,颜面偏斜得到有效矫正,咬合关系恢复正常。结论术前应用CAD/CAM快速原型技术制备预成钛网、联合自体松质骨游离移植二期修复单侧下颌骨缺损,不仅可以缩短手术时间,还能最大限度地重建下颌骨解剖外形、恢复患者颜面外观和咬合功能。

Objective The purpose of this clinical study was to explore the effective method of secondary reconstruct of unilateral mandible defects that caused mandible deviation and occlusal disorder. Methods Nine patients with unilateral mandible defects, with obvious mandible deviation and occlusal disorder, were included. The virtual models of cranio-maxillofacial bone were created by 3-demensional CT can. Mandible of the unaffected side was copied to the affected side by reflection method of computer-aided design system （CAD）. Solid physical models of the rehabilitated mandible were created by computer-aided manufacture （CAM） and rapid prototyping technique. The titanium mesh was prefabricated accurately on the solid model. 9 iliac cancellous bone grafts were harvested and used to repair unilateral mandible defects in combined with titanium mesh cages. Results All grafts survived entirety without complication and the contours of mandibles were satisfying. Significant improvement of the facial symmetry and occlusion in 9 patients were observed after treatment. Conclusions Satisfactory aesthetic and functional results could be achieved by CAD/CAM combined with autogenous cancellous bone grafts for secondary reconstruction of unilateral mandible defect.