数字化三维打印硅胶肋软骨模型在耳再造术的效果

Application of digital technology and three-dimensional silicone cartilage models in auricular reconstruction surgery

目的数字化技术制备小耳畸形患者供区硅胶肋软骨模型,探讨耳支架雕刻手术模拟在耳再造术的效果。方法2018年6月至2019年10月,南方医科大学南方医院整形美容科就诊的先天性小耳畸形患者19例,男16例、女3例,年龄8~35岁,平均16岁。用Mimics软件行供区肋软骨三维重建,通过三维打印制备肋软骨硅胶模型,术中按照模拟手术完成耳支架雕刻。术后6个月复诊,对比两侧耳郭的外形、大小、位置和耳颅角,按照Likert五分量表法评估患者对手术的满意度。结果19例患者均在术前行硅胶肋软骨耳支架雕刻的模拟和训练。术中按照模拟手术雕刻方案顺利完成耳再造手术,雕刻时间缩短至1.0~1.5 h,术后无血肿、感染、皮肤坏死及支架外露等并发症。术后6个月随访,再造耳外形清晰、自然,与模拟手术相吻合。19例患者对手术效果均较满意。结论数字化技术及三维打印硅胶肋软骨模型用于小耳畸形患者支架雕刻的模拟,可实现支架个性化雕刻和精准拼接,缩短手术时间,提供一种安全有效的支架雕刻训练方法。

Objective To establish silicone cartilage models of donor-sites for the microtia patients by using digital technology,and to explore the application of surgical simulation in auricular reconstruction.Methods From June 2018 to October 2019,19 congenital microtia patients underwent thoracic CT scans and following three-dimensional costal cartilage imaging with Mimics software at the Nanfang Hospital,Southern Medical University.Among these patients,16 were males and 3 were females.The mean age of patients was 16 years(range 8 to 35 years).Silicon cartilage models were produced by 3D printing and used for surgical planning and preoperative simulation in ear framework fabrication.Cartilaginous framework was sculptured according to the simulation during operation.Patients were followed up for a minimum of six months 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 All the patients received the surgical simulation and sculpture training with silicone cartilage models before operation.Auricular reconstruction was completed successfully according to the simulation.The duration of sculpture was shortened to 1-1.5 hours.There were no serious complications,such as hematoma,inflammation,skin necrosis and framework exposure.The contour of reconstructed ear was natural and clear over a 6 months follow-up,and all the patients were satisfied with their surgical outcomes.Conclusions With the application of digital technology and silicone cartilage models by 3D printing to the surgical planning and training in microtia patients,patient-specific framework is fabricated with precisely assembling,which not only shortens the operation time,but also provides the unexperienced surgeons with a safe and effective training of ear framework fabrication.