用SLS法定制修复下颌骨缺损的钛植入体的实验研究

目的：探讨应用SLS法定制钛植入体修复下颌骨缺损的可行性。方法：通过螺旋CT图像重建人下颌骨三维数据并制作单侧骨缺损模型,采用健侧数据镜像反转方法获得修复缺损的植入体CAD数据模型,用SLS法将CAD数据转换成蜡模,经失蜡铸造制作纯钛植入体,通过定点测量比较植入体与CAD模型的几何差异。结果：所制作的钛植入体形态自然,尺寸精度高。结论：应用SLS法定制修复下颌骨缺损的植入体精度高,耗时短,是一种很有前景的个性化修复下颌骨缺损的方法。     

快速原型结合镜像技术制作个性化钛板治疗单侧复杂颧骨骨折

目的：应用计算机辅助技术制作个性化钛板治疗单侧复杂颧骨骨折,并利用计算机三维测量技术评价其治疗效果。方法：10例单侧复杂颧骨骨折的患者,其中男性8例,女性2例。应用图形处理软件,以CT数据为基础,行颧面部三维重建,镜像翻转复制健侧颧骨替代患侧颧骨,制作个体化钛板后手术治疗颧骨骨折。术后通过计算机图形处理软件测量颧骨位置评价疗效。术后所有病例未出现相关并发症。结果：计算机辅助制作个性化钛板技术在重建颧骨形态和位置方面具有明显优越性。结论：快速原型结合镜像技术制作个性化钛板技术可以更加精确地恢复颧骨位置。     

3D打印技术在单侧粉碎性颧骨颧弓骨折治疗中的应用

目的 探讨3D打印技术在粉碎性颧骨颧弓骨折治疗中的应用价值。方法 选择2014年1月—2017年4月期间在西安交通大学口腔医院就诊的单侧粉碎性颧骨颧弓骨折21例。术前行薄层CT扫描,并将CT数据导入计算机辅助设计软件;进一步在计算机中将健侧颧骨颧弓镜像至患侧,最终打印出“复位”理想的患侧颧骨颧弓形态模型。在此模型上,进行内固定钛板预成型。术中利用预成型的内固定钛板引导骨段复位并最终完成内固定。术后行CT复查,三维测量颧骨颧弓位置并与术前设计位置进行比较,评估手术效果。采用SPSS 25.0软件包对测量数据进行配对t检验。结果 术后关键标志点间距同术前设计差异无统计学意义,手术效果满意。结论 3D打印技术有助于术前设计和植入物精确塑形,能有效提高单侧粉碎性颧骨颧弓骨折复位的精确性。     

计算机辅助设计和制作单侧眼眶部缺损的修复

目的　了解反求工程和快速成型技术对单侧眼眶部缺损进行计算机辅助设计和制作的效果。方法　通过激光扫描仪对一例单侧眼眶部缺损石膏面部模型进行数据采集。经反求工程软件处理,依据健侧眼眶部组织数据设计出缺损处修复体表面数据,并利用模具软件设计出修复体模型的三维数据。最后通过快速成型方法制作出修复体的树脂模型。结果　激光扫描采得的模型点云数据清晰精确。利用健侧眼眶部组织数据修复患侧缺损获得满意效果之后设计制作出的树脂修复体与缺损处贴和紧密并达到逼真的对称修复效果。结论　利用反求工程和快速成型方法可以满意地完成单侧眼眶部缺损修复的计算机辅助设计和制作。     

颧弓解剖测量及其应用解剖

目的测量成年人的颧弓解剖参数,为研制一种新型的颧弓骨折固定器提供解剖依据。方法用游标卡尺测量107个干颅骨标本(男56个,女51个)的颧弓。测量内容包括颧弓上下缘弦长、颧弓深度、颧弓厚度、颧弓宽度和颧弓下缘厚度。结果男性、女性颧弓相关测量的各项结果左右比较,男性、女性颧弓左右差异无显著性。男女性颧弓相关测量的各项结果男女比较,有显著性差异。男性颧弓的上下缘弦长、宽度、深度、厚度和下缘厚度均大于女性颧弓。结论颧弓下缘处不宜行钛板钛钉坚强内固定,坚强内固定的位置应是颧弓外表面中轴线上。     

计算机导航结合个性化钛网在颧上颌复合体伴眶壁骨折重建手术中的应用

目的 ：探讨计算机导航结合个性化钛网进行颧上颌复合体（zygomaticomaxillary complex, ZMC）伴眶壁骨折修复重建手术的临床效果。方法：回顾性分析2018年6月—2020年12月我院收治的6例ZMC伴眶壁骨折患者的临床资料,所有患者均应用计算机导航及个性化钛网进行骨折修复重建手术。测量术前、术后健侧与患侧的眶容积,并采用配对t检验比较术前、术后健侧与患侧的眶容积差。术后常规复查,对瞳孔位置、复视情况、伤口愈合情况、面部外观及相关功能进行评价并随访,术后随访3～12个月。结果：术前健侧与患侧的眶容积差为（5.25±2.34） mL,术后健侧与患侧的眶容积差为（1.98±1.21） mL,两者差异有统计学意义（P<0.05）;术后复视情况为5例治愈,1例好转;所有患者术前均有不同程度的瞳孔位置变化及眼球运动功能障碍,术后所有患者瞳孔位置变化及眼球运动功能障碍均得到明显改善;所有患者手术创口愈合良好,均未出现神经损伤、感染、植入体排斥等并发症,患者对术后外形、功能恢复满意。结论：计算机辅助手术导航结合个性化钛网进行ZMC伴眶壁骨折修复重建是一种精确、可行的方法,...     

单侧眶部缺损患者面部三维数字化重建及眼部测量

目的:建立单侧眶部缺损患者睁眼面部三维数字化模型,对健侧眼眶部主要标志点、线进行三维测量,为眶部赝复体的制作提供必要的测量数据.方法:采用3DSS结构光三维扫描仪,结合geomagic软件对一单侧眶部缺损患者进行三维重建,并对健侧眼部进行三维测量.结果:建立了患者睁眼面部三维数字化模型,获得了眼眶部各个标志点、线的测量数据.结论:睁眼三维面部数字化模型及其测量数据能够为单侧眶缺损修复提供必要的参考依据.     

预成钛网联合自体髂骨及松质骨游离移植二期修复单侧下颌骨缺损

目的 探讨已形成下颌偏斜、咬合错乱的单侧下颌骨缺损二期修复的有效方法.方法 对单侧下颌骨部分切除造成下颌偏斜和咬合错乱的9例患者行术前CT扫描,计算机辅助设计与制作(CAD/CAM)快速原型技术重建颅颌面骨三维数字模型,并以健侧下颌骨为模板,镜像形成缺损侧下颌骨.激光树脂成型机打印下颌骨实体模型,在实体模型上按缺损范围设计钛网,使预成钛网与缺损下颌骨外形一致.数控成型机制备钛网,切取髂骨及其松质骨,联合预成钛网植入完成下颌骨缺损二期修复.结果 预成钛网联合9例髂骨松质骨移植均获成功,创口愈合良好,下颌骨外形恢复满意,颜面偏斜得到有效矫正,咬合关系恢复正常.结论 术前应用CAD/CAM快速原型技术制备预成钛网、联合自体松质骨游离移植二期修复单侧下颌骨缺损,不仅可以缩短手术时间,还能最大限度地重建下颌骨解剖外形、恢复患者颜面外观和咬合功能.     

颧种植体在上颌骨缺损重建中的应用探讨

目的：评价颧种植体结合血管化骨瓣修复上颌骨缺损的效果。方法：对4例上颌骨切除术后缺损患者,利用三维CT数据,借助CAD／CAM系统制作1：1大小的解剖模型,术前测量相关参数并制作精确种植模板。术中采用血管化骨肌皮瓣和骨结合牙种植体修复上颌骨缺损,利用上颌骨和颧骨的测量数据．结合定位模板共植入6枚颧种植体和7枚牙种植体,颧种植体结合血管化骨瓣重建上颌骨的形态和功能。结果：利用血管化骨瓣重建4例患者的上颌牙弓形态,使面中1／3得以恢复：在术前设计和术中植入6枚颧种植体和7枚常规种植体时．应用解剖学模型和外科模板,使种植体精确定位。结论：上颌骨术后缺损,可采用颧种植体重建颧上颌支柱,恢复面中1／3的形态：使用血管化骨瓣结合颧种植体,提高了上颌骨缺损修复的效果;颧上颌支柱的恢复,使he的稳定得到了保证．从而有利于美观和功能的恢复。     

Mimics软件在颧骨复合体骨折三维CT图像中的测量与应用

目的探讨单侧颧骨复合体骨折移位的CT测量方法并用于指导临床手术。方法收集需要手术治疗的单侧颧骨复合体骨折患者20例,术前摄颌面部三维CT,利用Mimics软件对双侧颧骨复合体与邻近骨骼解剖标志点中选取的同样两点之间的距离和选取同样的三点之间的角度进行测量分析,计算患侧与健侧之间的差值,以此为骨折移位数据指导手术。术后复查CT并测量各段距离和角度,评价复位效果。结果1）颧骨复合体骨折时,颧骨体骨折块多向后、向内移位。术后患侧与健侧比较,骨折段移位距离差值减少至2 mm以内,角度差值减少至1°以内,复位达到三维对称,开口及咬合功能恢复好,手术效果满意。2）健侧的颧弓突点水平角和颧突点水平角数据呈正态分布,分别为138.50°±1.15°和132.72°±0.89°。结论三维CT测量可以实现对颧骨复合体空间移位的定量测量,对颧骨复合体骨折的手术复位具有指导意义。     

骨性Ⅲ类与Ⅰ类错患者基骨及牙弓宽度的比较研究

目的：评价骨性Ⅲ类错合与骨性I类个别正常合上下颌第一磨牙区基骨及牙弓宽度差异。方法：选取骨性Ⅲ类错合患者与骨性I类个别正常合样本各30例。测量CBCT数据中上颌骨颧弓点和下颌第一磨牙阻抗中心对应的颊侧骨皮质点间的距离作为基骨宽度；测量模型上下颌第一磨牙中央窝之间的距离作为牙弓宽度。使用SPSS 22.0独立样本t检验。结果：上颌基骨宽度Ⅲ类组（63.96±3.78mm）小于I类组（65.67±2.76mm）；下颌基骨宽度Ⅲ类组（62.26±3.12mm）大于I类组（60.29±3.15mm）；基骨宽度差为Ⅲ类组（2.31±2.41mm）小于I类组（5.38±1.24mm）。差异均有统计学意义（P<0.05）。Ⅲ类组与I类组上下颌牙弓宽度均无组间差异（P>0.05）。结论：骨性Ⅲ类患者存在上下颌基骨横向发育不调及上下颌磨牙的颊舌向代偿。     

内镜辅助下颧弓骨折切开复位内固定治疗的临床研究

目的探讨内镜辅助下行颧弓骨折复位内固定的相关技术及临床价值。方法选择18例患者,其中单侧颧弓骨折10例,单侧颧骨颧弓骨折8例,均在内镜辅助下经面部小切口暴露颧弓骨折断端,行断端解剖复位后,采用钛板在内镜辅助下进行颧弓骨折坚固内固定,恢复颧弓解剖形态。结果所有病例术后双侧颧部对称,无张口、咀嚼功能障碍及明显并发症发生。面部瘢痕隐蔽,无明显瘢痕畸形。术后CT检查显示颧弓颧骨基本解剖复位,钛板固定位置良好。结论 内镜辅助下经面部小切口行颧弓骨折复位内固定治疗,手术创伤小,骨折复位效果好,并发症少,可作为部分颧弓骨折病例治疗的选择术式。     

Digital localization of osteotomy position in prominent zygomatic arch

The study aimed at introducing a digital method of locating the osteotomy position of the zygomatic arch during surgery and analyze the accuracy of this method.Patients with a prominent zygomatic bone who underwent zygomatic arch osteotomy and reduction in the orthognathic surgery department of our hospital were selected. Preoperative and postoperative computed tomography (CT) data of the patients were imported into modeling and analysis software Mimics 23.0 in DICOM format to construct 3D models of the zygomatic bone and zygomatic arch region. The data were obtained by locating the simulated osteotomy position of the zygomatic arch before the surgery, applying the digitally modeled osteotomy position of the zygomatic arch during the surgery, and locating the actual osteotomy position of the zygomatic arch after the surgery. The accuracy of the experimental method was verified by matching the preoperative simulation data with the postoperative osteotomy data. A Wilcoxon rank sum test was performed to compare the 20 cases’ osteotomy positions obtained by preoperative simulation with the actual postoperative position. There was no significant difference in zygomatic arch osteotomy position between the preoperative simulation and the real postoperative position (Z=-1.867, P=0.062).The digital method to locate the zygomatic arch osteotomy seems to show an acceptable accuracy to achieve the proper osteotomy position and, therefore, should adopted whenever appropriate.     

Bone gap healing in the dog using recombinant human bone morphogenetic protein-2.

PURPOSE: This study investigated bone gap healing in a zygomatic arch defect using recombinant human bone morphogenetic protein-2 (rhBMP-2; Genetics Institute, Andover, MA) in an absorbable collagen sponge (ACS) carrier. METHODS: Zygomatic arch osteotomies were completed 15 mm apart and the arch was mobilized in 6 adult female mongrel dogs. The segment was then repositioned laterally 8 to 10 mm and secured with a titanium reconstruction plate. Bone gaps in either the right or left arches received rhBMP-2, with the contralateral side being left empty in 4 animals and the defects received buffer/ACS without rhBMP-2 in 2 animals as controls. Submentovertex radiographs were taken immediately postoperatively and every 4 weeks until killing at 12 weeks. RESULTS: Clinical evaluation indicated no significant differences in the degree of inflammation between the groups. However, the rhBMP-2 sites were found to be firm on palpation, in contrast to a soft tissue defect palpated in the control sites. Radiographic examination showed significant bone formation in all rhBMP-2 grafted sites as early as 4 weeks. The radiopacity of the bone continued to increase over the time of this study. Five of six control sites did not show bone formation through the course of this study. In addition to lack of bone formation, 5 of 6 control sites showed collapse of the repositioned arch. All arches in the rhBMP-2 sites remained in their lateral position and formed bone in the gaps. In 2 animals, bone formation moderately exceeded the confines of the gap, and in 2 animals excessive bone formation occurred. CONCLUSIONS: This study confirms that rhBMP-2 has the potential to be used to stimulate bone gap healing in the craniofacial complex.     

羊颧骨缝三维牵张成骨的组织学观察

目的探索不截骨的骨缝牵张成骨组织学变化。方法采用10～13个月龄普通山羊为实验对象，每只动物左颧骨行三维牵张成骨，固定1、3、5、8周后取材，和对侧空白对照标本比较，观察缝区组织变化、新骨形成情况。结果骨缝被牵开后1周，成纤维细胞、成骨细胞、毛细血管增生，大量纤维软组织排列有序并连接骨缝两侧，骨缝两侧组织面不整齐，牵张侧成骨活跃，大量类骨质形成；3周时形成较成熟的骨小梁；5周时编织骨形成；8周时结构成熟完整。结论不截骨的骨缝三维牵张成骨，骨缝牵张侧新骨快速形成；     

新型纳米羟基磷灰石复合树脂与牙本质的黏结性能评价

目的：检测新型纳米羟基磷灰石复合树脂与牙本质间的黏结强度,评价该材料对牙体组织的黏结性能。方法：健康离体磨牙36颗,随机分为3组,制作牙本质黏结面,分别黏结纳米羟基磷灰石复合树脂、复合树脂卡瑞斯玛、玻璃离子水门汀,经冷热交替试验后,测定各组试件的抗剪切力,计算剪切强度;体视显微镜下观察各组试件断裂界面断裂类型,采用SPSS17.0软件包对数据进行统计学分析。结果：纳米羟基磷灰石复合树脂的剪切强度为(11.23±4.6082) N/mm2,复合树脂卡瑞斯玛的剪切强度为(14.49±7.9855) N/mm2,玻璃离子水门汀的剪切强度为(10.08±6.3701) N/mm2,3组之间的抗剪切强度无显著差异;试件的黏结面断裂类型绝大多数为界面断裂,3组之间差异无显著性(P>0.05)。结论：纳米羟基磷灰石复合树脂作为一种新型牙体修复性材料,与牙体组织之间具有良好的黏结性能,达到了临床应用的要求。     

All-on-Four与穿颧种植在不同皮质骨厚度中的生物力学研究

目的：利用有限元分析法,比较在不同皮质骨厚度下后牙区垂直骨量严重不足的上颌无牙颌中All-on-Four与穿颧植体这两种不同种植设计中种植体、皮质骨的应力值与钛支架的变形量的差异,为临床种植方案的设计提供参考依据。 方法：选取一无牙颌上颌骨锥形束CT数据并利用其建立4个不同皮质骨厚度的模型,模型中还包括了种植体、基台、钛支架,在双侧后牙区施加200N垂直压力,计算出种植体、皮质骨的应力值及钛支架的变形量并进行统计分析。 结果：随着皮质骨厚度的增加,All-on-Four组与穿颧植体组中种植体、皮质骨应力值及钛支架变形量逐渐减小,在All-on-Four组中,当皮质骨厚度由0.5mm增加到1.5mm时,各数据降低明显,当皮质骨厚度由1.5mm增加到2mm时各数据变化较小,并且,当皮质骨厚度为1.5mm时,等效应力和变形量均达到一个较低的水平。在穿颧植体组中,随着皮质骨厚度的变化总体变化趋势均较小,穿颧植体组的种植体、皮质骨应力值及钛支架变形量均小于All-on-Four组,且5号位点皮质骨、2号位点皮质骨及钛支架变形量之间的差异有统计学意义（P<0.05）。 结论：对于后牙区垂直骨量严重不足的上颌无牙颌,皮质骨厚度的增加有利于减小种植修复的应力分布和钛支架的变形;当皮质骨厚度较小时（<1.5mm）,穿颧植体的种植方案是更为合适的选择;当皮质骨厚度较厚时（≥1.5mm）,虽然穿颧植体组中的数据表现较All-on-Four组好,但All-on-Four组中各数据已明显降低,此时,也可以考虑选择All-on-Four进行修复。     

Treatment of fractures of zygomatic bone and zygomatic arch. A method for the reduction of fracture by the use of U-shaped elevator

The occurrence of maxillofacial bone fractures has gradually increased. These were two-hundred-fifty-nine cases of maxillofacial bone fractures from 1981 to 1988, in which fourteen cases were fractures of zygomatic bone and zygomatic arch. (The number of the fractures of zygomatic bone, zygomatic arch, zygomatic bone and arch, and zygomatic bone and mandibular bone were 5, 2, 4, and 3 cases, respectively). Pathognomonic symptoms were infra-orbital neuroparalysis, tristmus and recess of the buccal region. The incisional for open reduction were applied for the lateral brow, the lower eyelid, or intra-oral approach. U-shaped elevator was used for the reduction and miniplate and stainless wire were used for fixation.     

Clinical analysis of isolated zygomatic arch fractures.

PURPOSE: The purpose of this study is to analyze the characteristics of isolated zygomatic arch fractures and to evaluate the functional and radiological outcomes of the treatment. PATIENTS AND METHODS: Forty patients with isolated zygomatic arch fractures were analyzed clinically. RESULTS: The patients were 25 males and 15 females with an average age of 42 years. The cause of injury was traffic accident in 26, followed by fall in 8, sports in 3, and assault in 3. The left side was involved in 25 cases. Fractures were classified into 5 types according to the degree of displacement and loss of bone contact. Reduction was performed in 31 patients, 26 treated by the Gillies temporal approach. Conservative treatment was chosen in 9 patients. The reduction status was excellent in 12 cases, good in 17 cases, and fair in 2 cases. There was no difference in the reduction status in terms of the fracture types or the interval between reduction and injury. Interincisal distance (IID) at maximal mouth opening recovered from 33.4 to 43.8 mm by excellent reduction, from 26.2 to 42.2 mm by good reduction, from 27.5 to 40 mm by fair reduction, and from 41 to 46.6 mm by conservative treatment. CONCLUSIONS: Good functional and radiological outcomes were obtained in isolated zygomatic arch fractures. Reduction status was not influenced by either the fracture type or the interval between reduction and injury, and recovery of IID was similarly achieved by excellent, good, and fair reduction.