两种3D打印导板在下颌角成形术中的适应证及应用效果研究

The Indications and Effects of Two Types of 3D-printed Surgical Guides in Mandibular Angle Ostectomy:A Comparative Study

目的分析不同数字化设计及3D打印导板在下颌角成形术中的应用效果。方法选取贵州医科大学附属口腔医院2022年1月至2023年1月收治的12例下颌角肥大患者作为研究对象。所有患者术前均行颅面部CT扫描用于三维模型重建,参考面部协调性及美观需求设计个性化下颌角截骨范围。所有患者均以下颌骨保留部分设计升支固定式截骨导板,以下颌角截除部分设计下颌下缘固定式截骨导板,术中根据不同3D打印导板使用情况分为升支固定组(组1)及下颌下缘固定组(组2)。比较两组患者术前术后下颌角形态变化。术后2周行颅面部CT扫描,重叠配准患者虚拟手术设计与手术后颅面部CT数据,测量手术设计与术后下颌角的偏差。结果所有患者均顺利完成下颌角截骨成形手术,患者对术后面型满意。组1患者术前下颌角均为外展型,组2患者中1例下颌角为外展型,其余患者下颌角为内卷型。所有患者术后下颌角角度显著高于术前(P<0.01),术后左、右侧下颌角角度对比差异无统计学意义(均P>0.05)。两组患者手术设计与术后下颌下缘之间前部、中部、后部偏差水平对比差异无统计学意义(均P>0.05)。结论数字化设计及3D打印导板引导下颌角截骨成形术具有较高的精确性,可获得良好的美容效果;升支固定式截骨导板适用于下颌角外展型患者,下颌下缘固定式截骨导板更适合下颌角内卷型患者。

Objective This study aimed to analyze the use of various virtual surgical planning and 3D printing templates in mandibular angle ostectomy.Methods Twelve patients with mandibular angle prominence were selected from the Affiliated Stomatological Hospital of Guizhou Medical University between January 2022 and January 2023.Preoperative craniofacial CT scans were used to create three-dimensional models.Two types of virtual surgical planning and templates were designed:ascending branch-fixed templates on the ramus(GroupⅠ)and inferior border-fixed templates on the excised mandibular angle(GroupⅡ).Patients were divided into two groups based on the template used during surgery.The changes in the mandibular angle before and two weeks after surgery were compared between the groups,and deviations between the surgical plans and postoperative results were measured.Results All patients healed successfully with satisfactory cosmetic outcomes.Lateral mandibular angles were observed in all patients of GroupⅠ.In GroupⅡ,one patient presented with a lateral angle,while the others showed medial angles.An increase in the mandibular angle(P<0.01)was noted with no significant difference between the bilateral angles(P>0.05).The deviation from the surgical planning was also not significantly different between the groups(P>0.05).Conclusion Virtual surgical planning and 3D printed templates in mandibular angle ostectomy result in high accuracy and favorable cosmetic outcomes.Ramus-fixed template is suitable for lateral mandibular angle type,while lower edge-fixed template is better for medial mandibular angle type.