3D打印导板用于眼眶手术钛网预成形的效果
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摘要
目的探讨3D打印导板用于眼眶手术钛网预成形的可行性并观察其初步效果。方法选取2013年1月~2015年12月在河北医科大学第二医院眼科行眼眶骨折手术的患者20例20只眼,术前眼球内陷均大于3 mm。所有患者术前行螺旋CT扫描,将所得数据利用Mimics软件进行三维重建,然后通过计算机辅助设计方法对眶壁缺损区域进行镜像修复,应用软件布尔运算中的减运算,以镜像后的眶壁数据减去原有的缺损眶壁数据,从而得到与眶壁缺损区域吻合的修复体模型。使用3D打印机打印修复体模型,以修复体模型作为钛网修剪及成形的导板,行眶壁修复成形术。术后观察视力、眼球突出度、复视等情况以评价手术效果。结果手术的20例患者术后6个月时均无视力下降;有17例患者眼球突出度之差≤2 mm;13例术前合并复视的患者,11例术后6个月时复视消失。3D打印导板有助于钛网与眶壁缺损区域更为精确的吻合,并缩短了手术中用于钛网成形的时间。结论3D打印的个体化手术导板可较好的用于钛网的三维预成形,有利于提高手术精确性,并缩短手术时间。
Objective To discuss the feasibility of 3D printing guide plate used for titanium mesh pre-forming in orbital surgery and observe its preliminary effect. Methods From January 2013 to December 2015, 20 patients(20 eyes)underwent orbital fracture surgery in the Second Hospital of Hebei Medical University were enrolled in the study. Preoperative eyeball invagination was greater than 3 mm. All the patients underwent spiral CT scan before operation. The data were reconstructed by Mimics software, and then the images were repaired by computer aided design. The subtraction operation in the Boolean operation of the software was applied, and the original defect orbital wall data were subtracted from the repaired image. 3D printing guide plate was used for titanium mesh pre-forming in orbital surgery. Visual acuity, exophthalmos and diplopia were observed after operation to evaluate the effect. Results No visual acuity was reduced at 6 months post surgery in the 20 patients, the difference of the protrusion of the eyes were equal to or less than 2 mm in 17 patients, diplopia disappeared in 11 patients at 6 months post operation. The 3D printing guide plate helped to achieve more precise anastomosis between titanium mesh and orbital defect area, and reduced the time required for titanium mesh formation in operation. Conclusion The individualized surgical guide plate can be used for3D pre-forming of titanium mesh, which is helpful to improve the accuracy of operation and reduce the operation time.
Objective To discuss the feasibility of 3D printing guide plate used for titanium mesh pre-forming in orbital surgery and observe its preliminary effect. Methods From January 2013 to December 2015, 20 patients(20 eyes)underwent orbital fracture surgery in the Second Hospital of Hebei Medical University were enrolled in the study. Preoperative eyeball invagination was greater than 3 mm. All the patients underwent spiral CT scan before operation. The data were reconstructed by Mimics software, and then the images were repaired by computer aided design. The subtraction operation in the Boolean operation of the software was applied, and the original defect orbital wall data were subtracted from the repaired image. 3D printing guide plate was used for titanium mesh pre-forming in orbital surgery. Visual acuity, exophthalmos and diplopia were observed after operation to evaluate the effect. Results No visual acuity was reduced at 6 months post surgery in the 20 patients, the difference of the protrusion of the eyes were equal to or less than 2 mm in 17 patients, diplopia disappeared in 11 patients at 6 months post operation. The 3D printing guide plate helped to achieve more precise anastomosis between titanium mesh and orbital defect area, and reduced the time required for titanium mesh formation in operation. Conclusion The individualized surgical guide plate can be used for3D pre-forming of titanium mesh, which is helpful to improve the accuracy of operation and reduce the operation time.
引文
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[12]冯辰栋,夏宇,李祥,等.3D打印多孔钛支架微观孔隙结构和力学性能[J].医用生物力学,2017,32(3):256-260.
[13]李靖,杨龙,王建吉,等.基于DICOM数据三维重建及其对骨科植入物的指导应用[J].中国组织工程研究,2017,21(7):1046-1051.
[14]向琳,代群霞,钟沐睿,等.爆裂性眼眶骨折修复手术前后眼外肌功能变化的临床特点分析[J].临床眼科杂志,2017,25(5):456-458.
[15]段春青,孙斌.眼球挫伤及伴眶爆裂性骨折者并发症临床分析[J].中华眼外伤职业眼病杂志,2018(1):23-25.
[16]李桂芬,易丽娜.预塑形钛网植入对眼眶骨折手术治疗预后的影响[J].国际眼科杂志,2017,17(3):516-518.
[17]胡艳.老年人眼眶肿瘤摘除术后预后的影响因素分析[J].临床眼科杂志,2017,25(2):145-147.
[18]韦超兵,赵立宇,方严,等.眼眶黏膜相关性淋巴样组织淋巴瘤的MRI成像特征及临床分析[J].临床眼科杂志,2017,25(4):350-352.
[19]姚登明,陈明,柴广睿,等.眼眶骨折修复术的临床应用研究进展[J].眼科新进展,2018,38(3):290-294.
[20]朱昭亮,马波.眼眶组织淀粉样变易误诊临床分析[J].中国医药导报,2016,13(30):118-121.
[2]孙凯建,王春霞,王雅文,等.应用个体化预成形钛网修复眶下壁骨折的临床分析[J].国际眼科杂志,2016,16(4):745-747.
[3]宋楠,叶信海.眼眶骨折重建技术进展[J].中国眼耳鼻喉科杂志,2018,18(1):15-17.
[4]季中锟,赵云,于莎莎,等.眼眶爆裂性骨折修复手术模拟的眼眶3D打印模形和外科种植体模形的研究[J].眼科新进展,2017,37(7):662-666.
[5]孙黎波,兰玉燕,张力,等.数字化模形制备个性化钛网修复眼眶骨折的应用[J].中国组织工程研究,2017,21(14):2158-2162.
[6]张翔,陈伟,曹罡,等.计算机辅助快速成形钛网在眼眶爆裂骨折整复中的应用[J].医学研究生学报,2016,29(4):407-410.
[7]李春威,陈珺.个体化3D打印眼眶模形辅助AO三维预成形钛网用于眼眶骨折手术临床观察[J].山东医药,2016,56(48):71-73.
[8]李桂芬,易丽娜.预塑形钛网植入对眼眶骨折手术治疗预后的影响[J].国际眼科杂志,2017,17(3):516-518.
[9]Kozakiewicz M,Szymor P.Comparison of pre-bent titanium mesh versus polyethylene implants in patient specific orbital reconstructions[J].Head Face Med,2013,9:32.
[10]Callahan AB,Campbell AA,Petris C,et al.Low-Cost 3D Printing Orbital Implant Templates in Secondary Orbital Reconstructions[J].Ophthalmic Plast Reconstr Surg,2017,33(5):376-380.
[11]Heufelder M,Wilde F,Pietzka S,et al.Clinical accuracy of waferless maxillary positioning using customized surgical guides and patient specific osteosynthesis in bimaxillary orthognathic surgery[J].J Craniomaxillofac Surg,2017,45(9):1578-1585.
[12]冯辰栋,夏宇,李祥,等.3D打印多孔钛支架微观孔隙结构和力学性能[J].医用生物力学,2017,32(3):256-260.
[13]李靖,杨龙,王建吉,等.基于DICOM数据三维重建及其对骨科植入物的指导应用[J].中国组织工程研究,2017,21(7):1046-1051.
[14]向琳,代群霞,钟沐睿,等.爆裂性眼眶骨折修复手术前后眼外肌功能变化的临床特点分析[J].临床眼科杂志,2017,25(5):456-458.
[15]段春青,孙斌.眼球挫伤及伴眶爆裂性骨折者并发症临床分析[J].中华眼外伤职业眼病杂志,2018(1):23-25.
[16]李桂芬,易丽娜.预塑形钛网植入对眼眶骨折手术治疗预后的影响[J].国际眼科杂志,2017,17(3):516-518.
[17]胡艳.老年人眼眶肿瘤摘除术后预后的影响因素分析[J].临床眼科杂志,2017,25(2):145-147.
[18]韦超兵,赵立宇,方严,等.眼眶黏膜相关性淋巴样组织淋巴瘤的MRI成像特征及临床分析[J].临床眼科杂志,2017,25(4):350-352.
[19]姚登明,陈明,柴广睿,等.眼眶骨折修复术的临床应用研究进展[J].眼科新进展,2018,38(3):290-294.
[20]朱昭亮,马波.眼眶组织淀粉样变易误诊临床分析[J].中国医药导报,2016,13(30):118-121.