个性化重建板辅助游离腓骨重建上颌骨半侧缺损的优化设计
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摘要
目的:利用CAD/CAM以及3D打印技术体外辅助游离腓骨瓣重建上颌骨半侧缺损。方法:利用CAD/CAM建立游离腓骨瓣重建上颌骨半侧缺损的三维模型,设计个性化重建板、截骨导板辅助重建完成,通过3D打印技术生成术前模型、截骨导板以及重建板,模型外科模拟手术。采用SPSS18.0软件包对数据进行统计学分析。结果:快速建立了3段式游离腓骨重建上颌骨缺损的数字化模型,并设计生成原发灶截骨导板和重建辅助个性化重建板。定点测量显示,模型外科模拟重建精度与计算机模拟无显著差异(P>0.05)。结论:优化设计的辅助措施和个性化重建板可以增加游离腓骨重建上颌骨缺损的准确性,有助于临床上精确外科重建。
PURPOSE: To optimize reconstruction of maxillary unilateral defect by free fibula flap rapidly through 3 D printing technique. METHODS: 3 D models of reconstruction of unilateral maxillary defect by free fibula flap was established via CAD/CAM, metal customized plates and resin osteotomy guides were designed and manufactured via 3 D printing technique, simulating operation was performed on models in vitro, and reconstructive accuracy after surgical simulation was analyzed using SPSS 18.0 software package. RESULTS: Digital models involving reconstructive bone and affiliated devices(plates and guides) were established and fabricated rapidly. There was no significant difference between simulating point on computer and surgical simulating point in vitro. CONCLUSIONS: The optimized design and customized plate can increase the accuracy of reconstruction of maxillary defects with free fibula in vitro, which is helpful for accurate surgical reconstruction.
PURPOSE: To optimize reconstruction of maxillary unilateral defect by free fibula flap rapidly through 3 D printing technique. METHODS: 3 D models of reconstruction of unilateral maxillary defect by free fibula flap was established via CAD/CAM, metal customized plates and resin osteotomy guides were designed and manufactured via 3 D printing technique, simulating operation was performed on models in vitro, and reconstructive accuracy after surgical simulation was analyzed using SPSS 18.0 software package. RESULTS: Digital models involving reconstructive bone and affiliated devices(plates and guides) were established and fabricated rapidly. There was no significant difference between simulating point on computer and surgical simulating point in vitro. CONCLUSIONS: The optimized design and customized plate can increase the accuracy of reconstruction of maxillary defects with free fibula in vitro, which is helpful for accurate surgical reconstruction.
引文
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[14]Ciocca L,Mazzoni S,Fantini M,et al.A CAD/CAM-prototyped anatomical condylar prosthesis connected to a custom-made bone plate to support a fibula free flap[J].Med Biol Eng Comput2012,50(7):743-749.
[15]Wilde F,Cornelius CP,Schramm A.Computer-assisted mandibular reconstruction using a patient-specific reconstruction plate fabricated with computer-aided design and manufacturing techniques[J].Craniomaxillofac Trauma Reconstr,2014,7(2):158-166.
[16]Bujtár P,Simonovics J,Váradi K,et al.The biomechanical aspects of reconstruction for segmental defects of the mandible:a finite element study to assess the optimization of plate and screw factors[J].J Craniomaxillofac Surg,2014,42(6):855-862.
[17]Hanasono MM,Chang DW.Discussion:Jaw in a day:total maxillofacial reconstruction using digital technology[J].Plast Reconstr Surg,2013,131(6):1392-1393.
[2]Rana M,Warraich R,Kokemüller H,et al.Reconstruction of mandibular defects-clinical retrospective research over a 10-year period[J].Head Neck Oncol,2011,3(1):23-30.
[3]Lenox ND,Kim DD.Maxillary reconstruction[J].Oral Maxillofac Surg Clin North Am,2013,25(2):215-222.
[4]Cordeiro PG,Chen CM.A 15-year review of midface reconstruction after total and subtotal maxillectomy:part II.Technical modifications to maximize aesthetic and functional outcomes[J].Plast Reconstr Surg,2012,129(1):139-147.
[5]Khanijow VK,Ahmad TS,Lian CB,et al.Mandibular reconstruction:experience with the free vascularized fibula transfer[J].Microsurgery,2010,14(6):375-379.
[6]Peled M,Elnaaj IA,Lipin Y,et al.The use of free fibular flap for functional mandibular reconstruction[J].J Oral Maxillofac Surg,2005,63(2):220-224.
[7]Gallegos-Hernández JF,Martinez-Miramón A.Fibular free-flap for mandibular reconstruction in patients undergoing mandibulectomy for oral cavity and bone tumors:10-year experience[J].Gac Med Mex,2008,144(2):85-90.
[8]Lim SH,Kim MK,Kang SH.Precision of fibula positioning guide in mandibular reconstruction with a fibula graft[J].Head Face Med,2016,12:7-17.
[9]Brown JS,Rogers SN,Mcnally DN,et al.A modified classification for the maxillectomy defect[J].Head Neck,2015,22(1):17-26.
[10]Rohner D,Bucher P,Hammer B.Prefabricated fibular flaps for reconstruction of defects of the maxillofacial skeleton:planning,technique,and long-term experience[J].Int J Oral Maxillofac Implants,2013,28(5):e221-229.
[11]Nkenke E,Eitner S.Complex hemimaxillary rehabilitation with a prefabricated fibula flap and cast-based vacuum-formed surgica template[J].J Prosthet Dent,2014,111(6):521-524.
[12]Shen Y,Sun J,Li J,et al.Special considerations in virtua surgical planning for secondary accurate maxillary reconstruction with vascularised fibula osteomyocutaneous flap[J].J Plas Reconstr Aesthet Surg,2012,65(7):893-902.
[13]Shipchandler TZ,Waters HH,Knott PD,et al.Orbitomaxillary reconstruction using the layered fibula osteocutaneous flap[J]Arch Facial Plast Surg,2012,14(2):110-115.
[14]Ciocca L,Mazzoni S,Fantini M,et al.A CAD/CAM-prototyped anatomical condylar prosthesis connected to a custom-made bone plate to support a fibula free flap[J].Med Biol Eng Comput2012,50(7):743-749.
[15]Wilde F,Cornelius CP,Schramm A.Computer-assisted mandibular reconstruction using a patient-specific reconstruction plate fabricated with computer-aided design and manufacturing techniques[J].Craniomaxillofac Trauma Reconstr,2014,7(2):158-166.
[16]Bujtár P,Simonovics J,Váradi K,et al.The biomechanical aspects of reconstruction for segmental defects of the mandible:a finite element study to assess the optimization of plate and screw factors[J].J Craniomaxillofac Surg,2014,42(6):855-862.
[17]Hanasono MM,Chang DW.Discussion:Jaw in a day:total maxillofacial reconstruction using digital technology[J].Plast Reconstr Surg,2013,131(6):1392-1393.