三维打印技术在颏部宽大及下颌角肥大截骨整复术中的应用

Application of three-dimensional printing technology in osteotomy for chin width and prominent mandibular angle

目的探讨运用计算机辅助设计(CAD)与三维打印技术(3DP)在颏部宽大及下颌角肥大综合智能化截骨整复术中的应用.方法收治颏部宽大及下颌角肥大患者16例,术前运用计算机辅助设计,头面部三维重建及下颌神经管重建,颏部和下颌综合智能化截骨线设计,智能化模拟颏部和下颌角截骨手术,三维打印颏部和下颌角手术截骨导板完成截骨手术,颏部截骨块钢板内固定.术前、手术模拟和术后分别测量患者两侧下颌角角度(Co-Go-Me)、下颌升支高度(Co-Go)、下颌体部长度(Go-Me)、面下宽(Go-Go')、颏结节宽度(Ge-Ge')、面高(N-Me).比较分析患者术前、手术模拟和术后两侧Co-Go-Me、Co-Go/Go-Me、Go-Go'/N-Me、Ge-Ge'/N-Me.结果患者术后下颌骨两侧几乎完全对称,均对自己面型满意,完全达到术前设计要求,所有患者术后均未发生感染、神经损伤等并发症.患者术前左右侧下颌角度数分别显著低于术后左右侧下颌角度数(t=2.890、2.886,P<0.05),下颌角模拟度数术前左右侧与术后左右侧比较差异无统计学意义(t=0.200、0.201,P>0.05),下颌角度数术后左右接近平均值(123.9±3.0)°,即貌美下颌角度数;患者术前左右侧Co-Go/Go-Me分别显著高于术后左右侧Co-Go/Go-Me(t=3.607、2.860,P<0.05),左右侧模拟Co-Go/Go-Me术前与术后比较分别差异无统计学意义(t=0.067、0.069,P>0.05),下颌骨体部长度和升支高度之比在术后左右两侧均接近2:1;患者术前Go-Go'/N-Me显著高于术后Go-Go'/N-Me(t =3.102,P<0.05),术前模拟Go-Go'/N-Me与术后Go-Go'/N-Me比较差异无统计学意义(t=2.011,P>0.05);术前Ge-Ge'/N-Me显著高于术后Ge-Ge'/N-Me(t=3.010,P<0.05),术前模拟Ge-Ge'/N-Me与术后Ge-Ge'/N-Me比较差异无统计学意义(t=2.010,P>0.05).结论计算机辅助设计与三维打印技术在颏部宽大及下颌角肥大综合智能化截骨整复术中的应用,可显著提高手术的精准度、降低手术难度,提高美容效果,减少感染、损伤重要神经血管等并发症的发生.

Objective To explore the applied value of computer-aided design and three-dimensional printing technology in osteotomy for chin width and prominent mandibular angle. Methods Sixteen patients with chin width and prominent mandibular angle were admitted to the Plastic Surgery Ward of the Second Affiliated Hospital of Zhengzhou University. All patients underwent preoperative computer-aided design, three-dimensional reconstruction of head and face, reconstruction of mandibular nerve canal, intelligent osteotomy line design of chin and mandible, simulation of chin and mandibular angle osteotomy, 3-D printing of surgical template to complete osteotomy, and internal fixation of chin osteotomy plate. The mandibular angle (Co-Go-Me), mandibular ramus height (Co-Go), mandibular body length (Go-Me), subfacial width (Go-Go’), chin nodule width (Ge-Ge’) and face height (N-Me) were measured preoperation, before surgical simulation and postoperation. Co-Go-Me, Co-Go/Go-Me, Go-Go’/N-Me and Ge-Ge’/N-Me were compared and analyzed in preoperation, before surgical simulation and postoperation. Results All the patients were satisfied with their facial shape. The mandible was almost symmetrical after operation. No complications such as nerve injury and infection occurred after operation, which fully met the preoperative design requirements. The mandibular angles in the left and right sides of patients before operation were significantly less than those after operation (t=2.890, 2.886, P<0.05). There was no significant difference in the mandibular angles in the left and right sides of patients before and after operation (t=0.200, 0.201, P>0.05). The average mandibular angles after operation were (123.9±3.0)°. Co-Go/Go-Me in the left and right sides of patients before operation was significantly higher than that after operation (t=3.607, 2.860, P<0.05). There was no significant difference in the simulated Co-Go/Go-Me in the left and right sides before and after operation (t=0.067, 0.069, P>0.05). The ratio of the length of the left and right mandibular body to the height of the ascending ramus was close to 2: 1. Preoperative Go-Go’/N-Me was significantly higher than that post-operation (t=3.102, P<0.05). Preoperative simulated Go-Go’/N-Me was not significantly different from post-operative Go-Go’/N-Me (t=2.011, P>0.05). Preoperative Ge-Ge’/N-Me was significantly higher than that post-operation (t=3.010, P<0.05). Preoperative simulated Ge-Ge’/N-Me was not significantly different from post-operative Ge-Ge’/N-Me (t=2.010, P>0.05). Conclusion The application of computer-aided design and three-dimensional printing technology in osteotomy for large chin and hypertrophic mandibular angle can significantly improve the accuracy of operation, reduce the difficulty of operation, improve the cosmetic effect, and reduce the occurrence of complications such as infection and injury of important nerves and blood vessels.