基于快速成型技术即刻精确修复下颌骨缺损的临床研究

目的：探索应用快速成型技术对下颌骨部分缺损进行即刻、精确与功能性修复的方法。方法：5例下颌骨缺损需即刻行外形和功能修复的患者,先行三维CT扫描获得颌面部影像数据,在计算机内进行三维重建;应用快速成型技术制作颌面部实体模型,在模型上进行模拟外科,确定手术部位、截骨点、重建钛板的方向和角度;同时,制作出缺损区骨质的树脂模型,指导修整移植骨块。术中,切除部分下颌骨后,根据术前模拟的方案,进行血管化的髂骨移植加重建钛板固定,或者单纯重建钛板固定。结果：5例下颌骨病变切除后均即刻行修复重建治疗。手术过程明显快捷、顺利,移植骨和重建钛板均简单修整即就位植入,术后患者的双侧面形对称,余留牙咬合关系良好、稳定,医患满意度均较高。结论：应用快速成型技术,对精确、快速地修复下颌骨缺损、恢复面部对称性、重建咬合功能等,是一种简便、有效、可推广的方法。

Clinical Study of Immediately and Accurately Reconstructing a Discontinuous Mandibular Defect Using Rapid Prototyping Technique

Objective： To investigate a method for immediate, accurate and functional reconstruction of a discon- tinuous mandible using rapid prototyping （RP） technique. Methods： 5 patients who had undergone block resection of mandible were involved, and need be reconstructed immediately. First,CT scanning was performed for the maxil- lofacial image data acquisition. After 3--dimensional reconstruction,the image data were transferred to RP device. Thus a geometric model was constructed according to the image data by repeating this process, and the real model RP was made. Preoperative analysis, surgery simulation, bending reconstruction titanium plate and implant of bone defect could be done on this computer--aided manufactured 3D model. At the same time, prosthesis resin model well--matched to mandibular defect was obtained to guide ilium bone graft. Finally, according to the preoperative method and model, the abnormal mar~dible was resected and repaired by free vascularized ilium flap, or fixed by sin- gle reconstruction titanium plate. Results~ All of the five patients were successfully underkvent immediate repair of mandibular defects by this fabricated method. The treatment process was significantly rapid and easy. Symmetric appearance and suitable mastication function was restored. Both the patients and the doctors were satisfactory. Con- clusion： RP technique is feasible and effective for immediate, functional and esthetic reconstruction of a mandibular defect.