外科医生主导的3D打印截骨导板在下颌骨肿瘤切除中的应用

Application of surgeon-dominated 3D printed osteotomy guides in the mandibular tumor resection

目的介绍由外科医生设计、商业公司打印的3D打印截骨导板在下颌骨肿瘤切除术中的应用经验,评价其精准性及优缺点。方法选取2021年1月至2023年12月期间,由北京大学口腔医院同一手术团队完成截骨导板设计及手术的下颌骨良性肿瘤及瘤样病变患者28例,记录截骨导板设计时间、治疗延迟时间(患者首次确诊到根治性手术治疗的时间),并通过将术后两周内的颌骨模型与术前设计相拟合,评估截骨平面角度和颊、舌侧标志点间的偏差,分析相关影响因素;另选取同期未使用手术导板的下颌骨良性肿瘤及瘤样病变患者23例作为传统组,记录治疗延迟时间,以及双侧髁顶点间偏差和双侧下颌角点间偏差,与导板组进行比较。结果导板组28例患者均在3D打印截骨导板的辅助下完成了肿瘤切除,截骨平面的颊侧偏差为2.12±1.06 mm、舌侧偏差为2.27±1.05mm,角度偏差为4.80±4.22°,导板长度、手术部位对导板的精准性无明显影响(P>0.05)。手术导板设计时间为43.9±34.5小时,导板组治疗延迟时间为25.1±20.7日;传统组治疗延迟时间为23.0±18.7日,两组间的差异无统计学意义(P>0.05)。导板组的双侧髁顶点间偏差为1.80±1.30 mm,传统组的双侧髁顶点间偏差为2.80±1.39 mm,两组间差异有统计学意义(P<0.05)。结论由外科医生主导设计手术导板有助于缩短导板的制备时间,精准还原术前设计。

Objective To presents the application experience of 3D printed osteotomy guides dominated by surgeons and printed by medical device company in mandibular tumor resection surgery.And evaluate the precision of these osteotomy guides and discusses the pros and cons of this approach.Methods A total of 28 patients with benign mandibular tumors treated by the same surgical team at Peking University School and Hospital of Stomatology from January 2021 to June 2023 were selected.Recording the design time of the osteotomy guide,treatment delay time(time from initial diagnosis to curative surgical treatment).Deviations between the postoperative mandibular model within two weeks and preoperative design were recorded to evaluate the osteotomy plane angle and deviations between buccal and lingual side landmarks,and to analyze related influencing factors.Additionally,23 patients with benign mandibular tumors during the same period who did not use surgical guides were selected as the traditional group,of which treatment delay time and the deviation between the condylion points were recorded for comparison with the surgical guide group.Results All of the 28 patients in the surgical guide group underwent tumor resection with the assistance of 3D printed osteotomy guides.The deviations on the buccal side and lingual side of the osteotomy planes were 2.12±1.06 mm and 2.27±1.05 mm,respectively,with an angle deviation of 4.80±4.22°.The precision of the surgical guides was not significantly influenced by the length of the guides or surgical site(P>0.05).The design time for the surgical guides was 43.9±34.5 hours,and the treatment delay time in the surgical guide group was 25.1±20.7 days.The treatment delay time for the traditional group was 23.0±18.7 days,with no statistically significant difference between the two groups(P>0.05).The deviation between the condylion points was 1.80±1.30 mm in the surgical guide group and 2.80±1.39 mm in the traditional group,and the difference between two groups was statistically significant(P<0.05).Conclusion Surgeon-dominated design of surgical guides facilitates reduced preparation time and accurate implementation of preoperative plans.