3D打印技术在正颌外科手术中的应用

3D Printing Technique in Application of Orthognathic Surgery

目的探讨3D打印技术在正颌外科手术中的应用效果。方法沈阳军区总医院整形外科2015年2—5月收治7例颌骨畸形患者。术前诊断5例为Ⅲ类咬合畸形,2例为Ⅲ类咬合畸形伴颏部发育不对称。首先采集患者三维CT扫描数据,应用3D打印技术打印与患者实体等大的上下颌骨模型,通过模型进行咬合关系分析,观察下齿槽血管神经束的位置,确定截骨线的部位。对伴颏部发育不对称者,利用模型进行体外模拟截骨,并制成导板,辅助指导截骨部位和大小。手术方式：LefortⅠ型截骨加矢状劈开截骨2例,单纯矢状劈开截骨加颏部水平截骨3例,矢状劈开截骨加颏部水平截骨加颏部局部修整2例。结果本组手术时间90~180 min,平均140 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。术后随访时间平均4.5个月,患者咬合并系明显改善,无血管神经损伤等并发症发生。结论 3D打印技术有利于更为精确地完成正颌外科手术,保证手术效果。

Objective To investigate the effect of 3-dimensional （3D） printing technique in application of or- thognathic surgery. Methods A total of 7 patients with maxillofacial deformities from February to May 2015 were recrui- ted in this study, and 5 patients were diagnosed as having class Ⅲ malocclusions and 2 patients with class Ill malocclu- sions accompanied with growth asymmetry of mental region before the surgery. The data of the patients was obtained by CT scanning to manufacture life-size 3D upper and lower jaw renal models using 3D printing technique. The models were used to analyze the occluding relation, observe the position of inferior alveolar neurovascular bundle and confirm the accu- rate site of osteotomy. Simulated osteotomy could be performed in vitro using the models for the patients accompanied with growth asymmetry of mental region, and then the operative guiding plates were manufactured to guide the site and size of osteotomy. The surgical methods included 2 patients undergoing Lefort I osteotomy accompanied with sagittal split osteoto- my, 3 patients undergoing sagittal split osteotomy accompanied with horizontal osteotomy and 2 patients undergoing sagit- tal split osteotomy accompaniod with horizontal osteotomy and part mental region of trimming. Results The operation time was 90-180 min, and the average time was 140 min. Primary healing of incisions was obtained in all the patients without such complications as infection, hematoma or difficulty in opening mouth. With an average of 4.5 months of fol- low-up, the occluding relation was obviously improved in all the patients without vascular nerve damage. Conclusion 3D printing technique is helpful for performing more accurate and effective orthognathic surgery.