3D打印技术在提高80例应用血管化腓骨移植修复下颌骨缺损精确度方面的临床探讨

Clinical application of 3D printing technology to improving accuracy of vascularized fibular graft for repairment of mandibular defect in 80 cases

摘要:

目的  探讨3D打印技术在提高80例应用血管化腓骨移植修复下颌骨缺损精确度方面所发挥的作用。方法  80例下颌骨病变患者在计算机辅助设计软件上模拟完成病变切除及腓骨移植修复重建，打印出重建后的实体模型及指导截骨和取骨塑形的数字化导板，并根据模型预弯制重建板。术后1周复查CT，再将患者的CT数据导入计算机辅助设计软件，对比实际手术与模拟手术截除的下颌骨颊舌侧与腓骨内外侧的长度误差。结果  实际手术截除颊侧下颌骨与模拟手术截除颊侧下颌骨误差（MB）为（0.99±1.06）mm；实际手术截除下颌骨舌侧与模拟手术截除下颌骨舌侧误差（ML）为（1.47±1.30）mm；实际手术截除腓骨内侧与模拟手术截除腓骨内侧误差（FM）为（1.41±0.97）mm；实际手术截除腓骨外侧与模拟手术截除腓骨外侧误差（FL）为（1.62±
1.46）mm。结论  3D打印技术在血管化腓骨移植修复下颌骨缺损方面可获得较高的精度。

Abstract:

Objective To explore the role of 3D printing technology in improving accuracy of the reconstruction of mandibular defect with vascularized fibula graft in 80 cases.  Methods For 80 cases of mandibular disease patients simulation of lesion resection and repair and reconstruction with fibular graft were completed using computer-aided design software. The entity model after reconstruction and digital guide for guidance of bone section  and bone remodeling were printed out, and then reconstruction plates were made according to  pre-bending of the model. The patients had CT scan again one week after operation. The patients' CT data were input to the computer-aided design software, then the lateral length errors of mandible buccal lingual side and medial and lateral fibula sides were compared between the actual operation and simulated osteotomy. Results The mandible buccal side error between actual surgical resection of the mandible and simulated surgery resection was(0.99 ± 1.06) mm, while the mandibular lingual side error was (1.47 ± 1.30) mm between actual and simulated surgical osteotomy of mandibula. The fibula medial side error between the actual operation excision and simulated surgical excision was (1.41 ± 0.97) mm, while the fibula lateral error between the actual operation excision and simulated surgical excision was (1.62±1.46) mm. Conclusions The use of 3D printing technology can obtain high accuracy in the reconstruction of mandibular defect with vascularized fibula graft.