三维打印技术在眶颧颌骨折术中的临床应用

Clinical application of 3D printing technology in the treatment of orbital-zygomatic-maxillary fractures

目的:探讨三维(three-dimensional,3D)打印技术辅助眶颧颌骨折手术的临床效果。方法 :回顾性分析眶颧颌骨折手术患者32例。所有患者术前经CT检查证实为眶颧颌骨折,并行个体化3D头颅模型打印。术中骨折复位后,以头颅模型作为导板修剪并塑形钛板后将其植入、固定。通过术前、术后患者的眼部检查,CT扫描,骨折术后综合评价体系来评价3D打印技术辅助眶颧颌骨折修复的治疗效果。采用Mann-Whitney U检验、Wilcoxon符号秩检验、配对资料的t检验进行统计学分析。结果:32例患者32侧眶颧颌骨折术前与术后1周双眼眼球突出度差值分别为(2.14±0.41) mm、(0.30±0.40) mm,眶区对称度分别为(9.00±1.08) mm、(1.45±0.46) mm,术后较术前均显著减小,差异均有统计学意义(P<0.01)。术后6个月,患者复视程度较术前明显改善(P<0.01);眼球运动障碍情况较术前明显改善(P<0.01)。疗效满意度评分为(9.81±0.47)分,外观恢复满意度评分为(9.06±0.88)分,患者对手术疗效及术后外观表现出较高的满意度。术后随访6~18个月,所有患者未出现严重的并发症。结论:3D打印技术应用于眶颧颌骨折修复的方法,手术效果良好,患者满意度高,是一种可行的辅助方法。

Objective:To evaluate the clinical effect of three-dimensional(3D)printing technology in the treatment of or-bital-zygomatic-maxillaiy fractures.Methods:A retrospective analysis of 32 cases of orbital-zygomatic-maxillary fractures was performed.All orbital-zygomatic-maxillary fractures were confirmed by computed tomography(CT)examination before operation,and individualized 3D skull models were printed.After intraoperative fracture reduction,the skull models were used as guide plates to trim and shape the titanium plates before implantation and fixation.The therapeutic effect of 3D printing technology in the repair of orbital-zygomatic-maxillary fractures was evaluated by preoperative and postoperative eye examination,CT scan,and postoperative comprehensive evaluation system.The data was analyzed by the Mann-Whitney U rank sum test,Wilcoxon and paired A test.Results:In the 32 sides orbital-zygomatic-maxillary fractures of 32 patients,the difference of bilateral exophthalmos before and 1 week after surgery was(2.14±0.41)mm and(0.30±0.40)mm,respectively,and the difference was significant(P<0.01).The orbital symmetry before and 1 week after surgery was(9.00±1.08)mm and(1.45±0.46)mm,respectively,and the difference was statistically significant(P<0.01).The degree of diplopia at 6-month after operation was significantly improved compared with that before operation(P<0.01).The degree of limi tation of extraocular muscle movement was significantly improved compared with that before operation(P<0.01).The curative effect satisfaction score was(9.81±0.47)points,and the appearance recovery satisfaction score was(9.06±0.88)points,and the patients showed high satisfaction with the surgical effect and postoperative appearance.All patients were followed up for 6-18 months,and no serious complications occurred intra-and post-operatively.Conclusion:The application of 3D printing technology in the repair of orbital-zygomatic-maxillary fractures achieved good surgical results and high patient satisfaction.It is a feasible auxiliary method.