计算机辅助虚拟手术设计结合3D打印技术在颌骨重建的应用研究

Application of combined use of computer-assisted virtual design and three-dimensional printing in reconstruction of mandibular bone

目的明确计算机辅助虚拟手术设计结合3D打印技术在颌面部骨缺损重建的应用模式及操作规范。方法选取2014—2016年眉山市中医院收治的14例颌骨创伤及肿瘤患者,其中男性9例,女性5例;平均年龄41.5岁。经医患沟通后患者同意采用虚拟手术方式进行术前设计,通过图像数据实现患者颌骨三维重建,利用计算机虚拟手术操作,确定最佳预期设计方案;根据计算机数据通过3D打印技术实现术前、术后模型重建,通过手术比较明确临床应用价值及操作规范。结果通过对14例患者实施术前设计及模型外科,创伤患者手术时间为2~6.5h,肿瘤患者手术时间为3~4.5h。14例患者术前利用3D打印模型制定手术方案,模拟手术步骤,其中13例手术入路及手术导板放置及螺钉植入均与术前方案一致;患者的手术时间较常规手术时间平均缩短近1h。术后随访3~6个月,患者对面部轮廓及咬合关系恢复情况,其中满意9例,较满意4例,不满意1例。结论计算机辅助虚拟手术设计为颌骨修复重建手术提供了重要的手术依据和临床数据;通过3D打印技术可提高手术质量,有效缩短手术时间,减少术中和术后并发症发生率。

Objective To elucidate the value of computer-assisted virtual design and three-dimensional printing in the management of maxillofacial bone defect.Methods A total of 14 patients with jaw trauma and tumor were enrolled in this study.There were 9 males and 5 females with an average age of 41.5 years.The preoperative computer virtual and simulated operation was performed with digital data from CT scanning.Three-dimensional model including pre-operation,post-operation and surgical guide were printed according to computer design scheme.In the actual operation,the difference of surgical protocol and the clinical value were compared with conventional surgery.Results Fourteen patients received the preoperative design and model surgery,the operation time of traumatic patients was 2-6.5h,and the operation time of tumor patients was 3-4.5h.All patients used 3D printing model before operation to develop surgical procedures to simulate the surgical procedures.The surgical approach,surgical guide plate placement and screw implantation were consistent with the preoperative program in 13 cases.The surgery time was shortened by one hour in comparison with the operation time of conventional surgery.Patients were followed up for 3 to 6 months.For the facial contours and occlusal relationship,9 cases were satisfactory and 4 cases were fair,and 1 case was not satisfactory.Conclusion Computer-assisted virtual design provides an important basis for the design of virtual surgery and clinical data for reconstruction surgery;3D printing technology can improve the quality of operation,effectively shorten the operation time,and reduce the risk of intraoperative and postoperative complications.