快速原型技术辅助复杂下颌骨重建术后颞下颌关节功能的评价

目的：研究快速原型技术对复杂下颌骨缺损重建术后患者髁突位置和颞下颌关节功能的影响。方法：对下颌骨良性肿瘤切除同时需保留髁突的复杂缺损重建术患者50例,其中20例用快速原型技术指导下颌骨重建（快速原型组）,30例用传统方法进行下颌骨重建（对照组）。所有患者手术前、后均行下颌骨及颞下颌关节三维螺旋CT扫描,测量髁突的三维空间位置,并用Fricton颞下颌关节功能量表进行术后颞下颌关节功能检查,计算颞下颌关节功能障碍指数（DI）、肌压痛指数（PI）及颞下颌关节紊乱指数（CMI）。采用SPSS11.5软件包,用配对t检验分析组内手术前、后差异,Mann-Whitney非参数检验分析组间差异。结果：所有肿瘤术后无复发,移植骨成活,关系良好。快速原型组外形对称,下颌运动功能正常,髁突位置正常。对照组6例面型不对称,8例CT显示患侧髁突有较明显的移位。快速原型组手术前、后的髁突前距离,内距离,上、下距离及长轴夹角数值无统计学差异。对照组手术前、后前距离有统计学差异（P〈0.05）,上、下距离及长轴夹角有显著性统计学差异（P〈0.01）,内距离无统计学差异（P〉0.05）。快速原型组及对照组组间术前髁突位置无统计学差异（P〉0.05）,而术后前距离及上、下距离有统计学差异（P〈0.05）,长轴夹角有显著性统计学差异（P〈0.01）,内距离无统计学差异（P〉0.05）。快速原型组及对照组间术后颞下颌关节各项功能指数中,DI及CMI差异有统计学意义（P〈0.05）,PI差异无统计学意义（P〉0.05）。结论：快速原型技术能通过保持髁突三维空间位置,改善术后颞下颌关节功能,提高下颌骨重建效果。

Evaluation of temporomandibular joint function after complicated mandible reconstruction guided by rapid prototyping technique

PURPOSE： To investigate the influences on patient’s condylar position and temporomandibular joint function after complicated mandible reconstruction by rapid prototyping technique. METHODS： Of fifty mandible benign tumor patients who underwent complicated mandible reconstruction with condyle preservation, twenty patients surgically guided by rapid prototyping technique were designed as rapid prototyping group, and 30 patients surgically guided by traditional methods were designed as control group. All patient’s pre -and postoperative condylar position were measured by mandible and temporomandibular joint three-dimensional CT scans. The temporomandibular joint function was evaluated by Fricton TMJ index, and dysfunction index（DI）, palpation index（PI） and raniomandibular index（CMI） were calculated accordingly. Data were compared between pre-and post-operative values with paired t test and between groups with Mann-Whitney nonparametric test using SPSS11.5 software package. RESULTS： Of all patients, there was no evidence of recurrence, the graft survived completely, and the post-operative occlusion was normal. Patients in the rapid prototyping group had symmetrical facial contour, normal condylar position and normal mandibular movement. Six patients in the control group had asymmetric facial contour. CT scans showed condylar position changed in 8 patients. There was no significant difference in the rapid prototyping group （P〉0.05）,while significant difference in the control group of condylar position between pre-and post-operation （P〈0.05）. There was no significant difference of preoperative condylar position （P〉0.05）, but significant difference of post-operative condylar position between the rapid prototyping and the control group （P〈0.05）. There was significant difference of post-operative temporomandibular joint function between the rapid prototyping and the control group （P〈0.05）. CONCLUSIONS： Rapid prototyping technique can improve the patient’s post-operative temporomandibular joint function after complicated mandible reconstruction by maintaining the condylar position.