计算机设计及辅助制作结合3D打印技术在颌骨肿瘤切除后骨缺损修复的应用
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摘要
颌骨肿瘤切除术后造成的骨缺损在颌面外科临床工作中十分常见,如何对复杂的骨缺损进行有效的功能修复仍存在诸多挑战。随着计算机辅助设计以及3D打印技术在口腔头颈肿瘤外科中的发展与应用,肿瘤切除术后颌骨缺损的修复变得更加精准和高效。以计算机辅助设计与制作(CAD/CAM)为代表的数字化技术的推广与普及,不仅提高了术前诊断的准确性,而且使手术方案设计变得更加精确。3D打印手术导板的使用则将肿瘤术后骨缺损修复的过程细化、量化,从而提高手术修复效率。本文结合绵阳市第三人民医院近5年颌骨肿瘤切除术后采用该技术修复骨缺损的相关经验以及国内外最新文献,讨论CAD/CAM结合3D打印技术在颌骨肿瘤术后骨缺损修复中的应用,并展示代表性病例。
Bone defects caused by resection of jaw tumors are very common in clinical work of maxillofacial surgery. How to effectively repair complex bone defects remains a lot of challenges. With the development and application of computer-aided design and 3D printing technology in oral head and neck cancer surgery,the reconstruction of jaw defects after tumor resection has become more accurate and efficient. The popularization and popularization of digital technology represented by computer aided design and production( CAD/CAM) not only improves the accuracy of preoperative diagnosis,but also makes surgical design more accurate. The use of 3D printing guide plate can refine and quantify the process of repairing bone defect after tumors surgery,so as to improve the efficiency of surgical repair. Based on 5 years' experience in repairing bone defects after resection of jaw tumors in XX Hospital and the latest literature at home and abroad,this paper discusses the application of CAD/CAM combined with 3D printing technology in repairing bone defects after resection of jaw tumors and shows its representative cases.
Bone defects caused by resection of jaw tumors are very common in clinical work of maxillofacial surgery. How to effectively repair complex bone defects remains a lot of challenges. With the development and application of computer-aided design and 3D printing technology in oral head and neck cancer surgery,the reconstruction of jaw defects after tumor resection has become more accurate and efficient. The popularization and popularization of digital technology represented by computer aided design and production( CAD/CAM) not only improves the accuracy of preoperative diagnosis,but also makes surgical design more accurate. The use of 3D printing guide plate can refine and quantify the process of repairing bone defect after tumors surgery,so as to improve the efficiency of surgical repair. Based on 5 years' experience in repairing bone defects after resection of jaw tumors in XX Hospital and the latest literature at home and abroad,this paper discusses the application of CAD/CAM combined with 3D printing technology in repairing bone defects after resection of jaw tumors and shows its representative cases.
引文
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[22]Islam S,Uwadiae N,Ormiston IW.Orthognathic surgery in the management of obstructive sleep apnoea:experience from maxillofacial surgery unit in the United Kingdom[J].Br J Oral Maxillofac Surg,2014,52(6)∶496-500.
[23]洪文松,张力,陈兵锋,等,数学模型模拟分析在肿瘤放化疗中的应用[J].肿瘤预防与治疗,2018,31(3)∶161-165.
[24]Li Y,Jiang Y,Ye B,et al.Treatment of dentofacial deformities secondary to osteochondroma of the mandibular condyle using virtual surgical planning and 3-dimensional printed surgical templates[J].J Oral Maxillofac Surg,2016,74(2)∶349-368.
[25]Xu LC,Li CJ,Wang HN,et al.Distraction osteogenesis of fibula graft for mandibular reconstruction following ameloblastoma ablation[J].J Craniofac Surg 2019,30(1)∶202-204.
[26]Jung MK,Hagen ME,Buchs NC,et al.Robotic bariatric surgery:A general review of the current status[J].Int J Med Robot.2017,13(4).doi∶10.1002/rcs.1834.
[27]罗红兵,周鹏,青浩渺,等,计算机辅助检测系统在低剂量CT肺癌筛查中非钙化肺结节检出方法的研究[J].肿瘤预防与治疗,2017,30(1)∶33-38.
[28]Hamet P,Tremblay J.Artificial intelligence in medicine[J].Metabolism,2017,69S∶S36-S40.
[2]Poukens J,Haex J,Riediger D.The use of rapid prototyping in the preoperative planning of distraction osteogenesis of the craniomaxillofacial skeleton[J].Comput Aided Surg,2003,8(3)∶146-154.
[3]Gray R,Gougoutas A,Nguyen V,et al.Use of three-dimensional,CAD/CAM-assisted,virtual surgical simulation and planning in the pediatric craniofacial population[J].Int J Pediatr Otorhinolaryngol,2017,97∶163-169.
[4]Hou JS,Chen M,Pan CB,et al.Application of CAD/CAM-assisted technique with surgical treatment in reconstruction of the mandible[J].J Craniomaxillofac Surg,2012,40(8)∶e432-e437.
[5]Pang JH,Brooke S,Kubik MW,et al.Erratum to:staged reconstruction(delayed-immediate)of the maxillectomy defect using cad/cam technology[J].J Reconstr Microsurg,2018,34(3)∶e1.
[6]Dell'Aversana Orabona G,Abbate V,Maglitto F,et al.Lowcost,self-made CAD/CAM-guiding system for mandibular reconstruction[J].Surg Oncol.2018,27(2)∶200-207.
[7]Du W,Chen G,Bai D,et al.Treatment of skeletal open bite using a navigation system:CAD/CAM osteotomy and drilling guides combined with pre-bent titanium plates[J].Int J Oral Maxillofac Surg,2019,48(4)∶502-510.
[8]Xue C,Xu H,Tian Y,et al.Precise control of maxillary multidirectional movement in Le Fort I osteotomy using a surgical guiding device[J].Br J Oral Maxillofac Surg,2018,56(9)∶797-804.
[9]Jeon JH,Hwang SS,Kim JH,et al.Trueness and precision of scanning abutment impressions and stone models according to dental CAD/CAM evaluation standards[J].J Adv Prosthodont,2018,10(5)∶335-339.
[10]Bouchet B,Raoul G,Julieron B,et al.Functional and morphologic outcomes of CAD/CAM-assisted versus conventional microvascular fibular free flap reconstruction of the mandible:A retrospective study of 25 cases[J].J Stomatol Oral Maxillofac Surg,2018,119(6)∶455-460.
[11]Chung EL,Alawi F,Le AD,et al.Virtual surgical planning and piezoelectric surgery in tumor extirpative surgery aimed at inferior alveolar nerve preservation[J].Case Rep Surg,2017,2017∶4397178.
[12]Hara S,Mitsugi M,Kanno T,et al.Three-dimensional virtual operations can facilitate complicated surgical planning for the treatment of patients with jaw deformities associated with facial asymmetry:a case report[J].Int J Oral Sci,2013,5(3)∶176-182.
[13]Heller M,Bauer HK,Goetze E,et al.Applications of patientspecific 3D printing in medicine[J].Int J Comput Dent,2016,19(4)∶323-339.
[14]Ettinger KS,Alexander AE,Arce K.Computed tomographic angiography perforator localization for virtual surgical planning of osteocutaneous fibular free flaps in head and neck reconstruction[J].Joral maxillofac surg,2018,76(10)∶2220-2230.
[15]Farronato G,Galbiati G,Esposito L,et al.Three-dimensional virtual treatment planning:presurgical evaluation[J].J Craniofac Surg,2018,29(5)∶e433-e437.
[16]Landaeta-Quinones CG,Hernandez N,Zarroug NK.Computer-assisted surgery:applications in dentistry and oral and maxillofacial surgery[J].Dent Clin North Am,2018,62(3)∶403-420.
[17]Modabber A,Ayoub N,Bock A,et al.Medial approach for minimally-invasive harvesting of a deep circumflex iliac artery flap for reconstruction of the jaw using virtual surgical planning and CAD/CAM technology[J].Br J Oral Maxillofac Surg,2017,55(9)∶946-951.
[18]Tarsitano A,Battaglia S,Ricotta F,et al.Accuracy of CAD/CAM mandibular reconstruction:A three-dimensional,fully virtual outcome evaluation method[J].J Craniomaxillofac Surg,2018,46(7)∶1121-1125.
[19]Mardini S,Alsubaie S,Cayci C,et al.Three-dimensional preoperative virtual planning and template use for surgical correction of craniosyrwstosis[J].J Plast Reconstr Aesthet Surg,2014,67(3)∶336-343.
[20]Mascha F,Winter K,Pietzka S,et al.Accuracy of computer-assisted mandibular reconstructions using patient-specific implants in combination with CAD/CAM fabricated transfer keys[J].J Craniomaxillofac Surg,2017,45(11)∶1884-1897.
[21]Lee JH,Han IH,Choi BK,et al.Virtual preoperative simulation for excision of spinal tumors:surgeon processing of medical computer-assisted design softwar[J].Korean J Spine.2017,14(4)∶170-174.
[22]Islam S,Uwadiae N,Ormiston IW.Orthognathic surgery in the management of obstructive sleep apnoea:experience from maxillofacial surgery unit in the United Kingdom[J].Br J Oral Maxillofac Surg,2014,52(6)∶496-500.
[23]洪文松,张力,陈兵锋,等,数学模型模拟分析在肿瘤放化疗中的应用[J].肿瘤预防与治疗,2018,31(3)∶161-165.
[24]Li Y,Jiang Y,Ye B,et al.Treatment of dentofacial deformities secondary to osteochondroma of the mandibular condyle using virtual surgical planning and 3-dimensional printed surgical templates[J].J Oral Maxillofac Surg,2016,74(2)∶349-368.
[25]Xu LC,Li CJ,Wang HN,et al.Distraction osteogenesis of fibula graft for mandibular reconstruction following ameloblastoma ablation[J].J Craniofac Surg 2019,30(1)∶202-204.
[26]Jung MK,Hagen ME,Buchs NC,et al.Robotic bariatric surgery:A general review of the current status[J].Int J Med Robot.2017,13(4).doi∶10.1002/rcs.1834.
[27]罗红兵,周鹏,青浩渺,等,计算机辅助检测系统在低剂量CT肺癌筛查中非钙化肺结节检出方法的研究[J].肿瘤预防与治疗,2017,30(1)∶33-38.
[28]Hamet P,Tremblay J.Artificial intelligence in medicine[J].Metabolism,2017,69S∶S36-S40.