3D打印技术结合可塑形钛网在修复上颌骨缺损中的应用

Application of 3D computer-assisted printing technique combined with plastic titanium mesh in the reconstruction of maxillary defect

目的探讨3D打印技术结合可塑形的个体化钛网在修复上颌骨缺损中的应用。方法回顾性分析2016年1月至2018年6月,上海交通大学医学院附属第九人民医院耳鼻咽喉头颈外科收治的因上颌骨良恶性肿瘤行上颌骨部分或全部切除、或严重复合性外伤后的获得性上颌骨缺损的患者共14例,男性12例,女性2例,年龄16~51岁。其中鳞状细胞癌2例;良性肿瘤7例,包括血管瘤1例、骨纤维异常增殖症3例、骨囊肿2例和骨巨细胞瘤1例;复合性上颌骨外伤5例。根据术前薄层CT扫描数据,通过计算机建模数据传送至3D打印机,分别打印出原始状态和重塑后的上颌骨树脂模型。在患者的原始模型上,术前模拟肿瘤切除和上颌骨重建,在重塑的模型上塑形钛网,使其能恰当重建缺损的骨结构。术中将预制好的钛网植入缺损区域,将软组织瓣复位,分层缝合,术后局部加压包扎。术后通过临床和CT检查,评价患者颌面部外形、鼻腔功能及并发症情况。采用描述性统计学方法对结果进行分析。结果所有肿瘤病例均能在术前3D打印模型预测的范围内完整切除病灶,与外伤病例在清创后植入钛网一样,无需于术中再次对钛网进行塑形和修剪,钛网可完整覆盖缺损的骨面,周边贴合紧密,钛钉固定顺利,植入钛网坚固稳定。术后随访6~20个月,患者对面部外形满意,功能恢复良好。结论3D打印技术结合可塑形钛网应用于上颌骨缺损的修复,能精确恢复上颌骨骨性结构对于软组织的支撑,恢复面部形态及功能。

Objective To investigate the application and clinical outcomes of using 3D computer-assisted printing technique combined with plastic titanium mesh in the reconstruction of maxillary defect.Methods Clinical data of 14 patients in Department of Otorhinolaryngology Head and Neck Surgery,Shanghai Ninth People′s Hospital from January 2016 to June 2018,who were treated for partial or total removal of the maxilla due to benign or malignant tumors and those acquired maxillary defects caused by severe compound trauma were analyzed retrospectively.Twelve males and 2 females were included,with the age ranging from 16 to 51 years old.The sinonasal malignant tumors included squamous carcinoma(n=2)while benign tumors included hemangioma(n=1),maxillary fibrous dysplasia(n=3),maxillary cyst(n=2)and giant cell tumor of the maxilla(n=1).Five cases of post-traumatic maxillary defect were also included.According to preoperative thin-layer CT scanning data,computer modeling data was transmitted to a 3D printer to print out the original model and the reconstructed model.Preoperative simulation of tumor removal and maxillary reconstruction was done on the patient′s original model,and the titanium mesh was shaped on the reconstructed model in order to properly reconstruct the area needed to be repaired.The pre-made titanium mesh was implanted into the defect area,the soft tissue flaps were reset,layered stitching and the local pressured bandage were used after surgery.Through postoperative clinical and CT examination,the patient′s maxillofacial shape,nasal function and complications were evaluated.The results were analyzed by descriptive statistical method.Results Lesions could be completely removed within the predicted range on the preoperative 3D-printed models of all cases.After debridement,titanium mesh could be implanted easily without re-shaping and trimming during surgery as in trauma cases.Titanium mesh could completely cover the missing bone surface closely,with titanium nails fixed smoothly,and the implanted titanium mesh was solid and stable.After the follow-up of 6 to 20 months,all patients were satisfied with the facial symmetry and the function was recovered well.Conclusion Using 3D computer-assisted printing technique combined with plastic titanium mesh in the reconstruction of maxillary defect can accurately restore the maxillary structure for soft tissue support,and restore the facial shape and function.