激光快速成形技术用于陈旧性眶颧复合体骨折整复临床探讨

Clinical investigation on the reconstruction of obsolete orbitozygomatic fracture by means of laser rapid prototyping technology

目的利用激光快速成形技术建立的眼眶骨的实物模型，对陈旧性眶颧复合体骨折的整复手术及临床效果进行探讨。方法对2012年4—10月在四川省人民医院眼科将陈旧性眶颧复合体骨折患者3例，通过对眼眶横断面、矢状面、冠状面CT断层扫描，按需求获得健侧眼眶各曲面的数据及对侧损伤部位的眼眶曲面数据。利用人体对称性原则，通过镜像原理，虚拟生成另一侧眼眶的未损伤前的数据。将眼眶曲面数据建构、编辑、修改生成通用输出格式的曲面数字化模型。通过激光快速成形技术，建立损伤的眼眶骨实物模型及修复模型。通过模型比对、模拟，预制钛网形态。手术中按照术前的模拟，完成钛网的植入。结果3例患者伤口均一期愈合，手术切口隐蔽，手术时间缩短。无一例患者出现视力丧失。患者无主观异物感或移动感，体表无植人体轮廓阴影或阶梯状畸形。CT扫描复查钛网无松脱移位。患者复视及眼球运动障碍改善，眼球内陷好转，患者外观满意。术后随访6个月，未发现钛网排斥反应、移位、感染及其他不良反应。结论将激光快速成形技术用于眼眶陈旧性眶颧复合体骨折整复。可以提高手术的目的性和准确性，极大地缩短了手术时间，提高了手术的安全性，减少了手术创伤，对术后外观的恢复也更加理想。

Objective To analyze the character of the orbital bone model which constructed by rapid prototyping and evaluate its application in the reconstruction of obsolete orbitozygomatic frac- ture. Methods Three patients with obsolete orbitozygomatic fracture were chosen. With CAD tech- niques, 3D bone model was reconstructed based on CT images. Then, a repairing model was created with mirror operation on original model. The physical models of original model and repairing model were fabricated through rapid prototyping. Based on physical models, operation plan and model sur- gery with pre-bent titanium mesh could be designed. Results The designed operation plan and pre-forming plates by means of laser rapid prototyping technology were successfully applied in 3 pa- tients with satisfactory results. Conclusions For reconstructing and fabricating the original bone model and mirroring the repair model, laser rapid prototyping technology is very helpful for design- ing operation plan for obsolete orbitozygomatic fracture surgery. It also can improve the surgery accu- racy and save operation time obviously.