数字化技术辅助设计和雕刻耳再造支架

Surgical design and fabrication of ear framework for auricular reconstruction based on digital technique

目的探讨运用三维数字化技术辅助设计个性化耳支架在耳再造术中的临床应用。方法选取2018年7月至2019年10月就诊于南方医科大学南方医院整形美容外科的先天性小耳畸形患者,均拟行耳再造手术。对单侧小耳畸形患者进行耳部CT扫描,应用Mimics 18.0软件行术前分析和耳支架设计,通过等比例打印和三维打印分别制作二维胶片和三维硅胶耳模,完成耳再造术。术后半年复诊,对比分析两侧耳廓的外形、大小位置和耳颅角,根据Likert五分量表法评估患者对手术的满意度。结果共选择15例患者,男11例,女4例,年龄8~27岁,平均15.5岁。患者均成功完成术前设计规划和耳再造手术。术中肋软骨耳支架与三维打印支架的形态及大小非常相近,术后未发生血肿、感染、皮肤坏死、支架外露等并发症。术后半年左右两侧耳对比,再造耳轮廓清晰,与对侧接近。所有患者术后对再造耳外形均较为满意,平均满意度4.4分。结论将数字化技术应用于小耳畸形患者的术前设计和支架雕刻,耳模制备由传统的二维走向三维,小耳畸形的治疗由传统的标准化耳再造转变为个性化耳再造,显著地提高了手术精准度。

Objective To investigate the application of three-dimensional digital technique in customized ear framework fabrication for auricular reconstruction.Methods From July 2018 to October 2019,the patients with microtia who underwent ear reconstruction in the Department of Plastic and Aesthetic Surgery,Nanfang Hospital,Southern Medical University were enrolled.Each patient with unilateral microtia underwent auricular CT scan and preoperative analysis and ear framework design were carried out with Mimics software 18.0.The two-dimension(2D)ear films and three-dimension(3D)silicon models were produced by 1∶12D printing and 3D printing,respectively.Microtia reconstruction was performed according to the guide of the models,patients were followed up over a six-month period to evaluate the size,outline,height and auriculocephalic angle of the reconstructed ear.The satisfactory outcomes of the patients were scored according to a 5-point Likert scale.Results A total of 15 patients were included in this study,including 11 males and 4 females,aged 8-27 years,with an average of 15.5 years old.All the 15 patients completed the surgical planning and ear reconstruction successfully,without major complications,such as hematomas,inflammation,skin necrosis and framework exposure.The costal cartilage frameworks were very similar to the printed 3D models in size and contour.Comparison between the two sides was made at six months postoperatively.The reconstructed ear was much the same as that of contralateral side,and all patients were satisfied with their reconstructed ear outcomes with average score of 4.4.Conclusions With the application of digital technique for pre-surgical planning in microtia reconstruction patients,ear templates were produced from 2D to 3D,and the correction of microtia was changed from standard auricular reconstruction to personalized auricular reconstruction,with a great improvement of the precision in ear framework fabrication.