3-D打印技术制备人工骨修复下颌角截骨整形术后骨缺损

APPLICATION OF THREE-DIMENSIONAL PRINTING TECHNIQUE IN ARTIFICIAL BONE FABRICATION FOR BONE DEFECT AFTER MANDIBULAR ANGLE OSTECTOMY

目的探讨应用3-D打印技术结合三维CT及计算机辅助设计技术制作个性化人工骨，修复下颌角截骨整形术后骨缺损，矫正下颌骨不对称畸形的效果。 方法2011年4月－2013年6月，收治23例曾行下颌角截骨整形术的女性患者。年龄22～34岁，平均27岁；术后发生双侧下颌骨形态不对称，下颌角截骨整形术至此次修复术时间为6～16个月，平均12个月。首先采集患者三维CT扫描数据，结合计算机辅助技术基于镜像原理设计个性化下颌角模型，应用3-D打印技术打印缺损模型并制作相应人工骨植入缺损区。 结果手术时间40～60 min，平均50 min。术后口内切口均Ⅰ期愈合，无感染、血肿、张口困难等并发症发生。23例均获随访，随访时间3～10个月，平均6.7个月。术后患者面部对称性显著改善，双侧下颌骨形态对称；术后3个月CT三维重建检查示人工骨契合度满意。 结论三维CT扫描、计算机辅助设计和3-D打印技术可以制作个性化人工下颌骨，为下颌角截骨整形术后不对称畸形治疗提供了一种精确和简便的方法。

Objective To investigate the application of three-dimensional （3-D） printing technique combining with 3-D CT and computer aided-design technique in customized artificial bone fabrication, correcting mandibular asymmetry deformity after mandibular angle ostectomy. Methods Between April 2011 and June 2013, 23 female patients with mandibular asymmetry deformity after mandibular angle ostectomy were treated. The mean age was 27 years （range, 22-34 years）. The disease duration of mandibular asymmetry deformity was 6-16 months （mean, 12 months）. According to the CT data and individualized mandibular angle was simulated based on mirror theory, 3-D printed implants were fabricated as the standard reference for manufacturers to fabricated artificial bone graft, and then mandible repair operation was performed utilizing the customized artificial bone to improve mandibular asymmetry. Results The operation time varied from 40 to 60 minutes （mean, 50 minutes）. Primary healing of incisions was obtained in all patients; no infection, hematoma, and difficulty in opening mouth occurred. All 23 patients were followed up 3-10 months （mean, 6.7 months）. After operation, all patients obtained satisfactory facial and mandibular symmetry. 3-D CT reconstructive examination results after 3 months of operation showed good integration of the artificial bone. Conclusion 3-D printing technique combined with 3-D CT and computer aided design technique can be a viable alternative to the approach of maxillofacial defects repair after mandibular angle ostectomy, which provides a accurate and easy way.