复合型人工骨预制体在颌面骨缺损修复中的应用

目的探讨计算机辅助设计与制造（CAD／CAM）技术制作的复合型人工骨预制体在个性化颌面骨缺损修复中的临床应用价值。方法对6例颌面骨缺损的患者利用复合人工骨进行骨缺损修复，术前对颌面骨缺损部位进行螺旋cT扫描并三维重建，应用计算机辅助设计软件、计算机辅助制造快速成型机、复合人工骨材料及一系列的工序处理后制成三维颌面模型及个性化的颌面骨预制体．术中在模型指导下将颌面骨预制体精确定位与固定。其中3例并明显皮肤软组织缺损患者．则予同期或二期行皮肤软组织缺损的修复。结果全部颌面预制体术中能准确快速的就位及固定．无预制体断裂等发生，转移修复皮肤软组织缺损的皮瓣血运良好．除1例经口内切口患者术后部分伤口裂开予二期清创缝合后伤口愈合外，余伤口愈合良好。随访6个月至4年，无预制体移位、排斥等并发症发生，双侧颌面外形基本对称，外形满意。结论应用CAD／CAM制成的个性化复合材料颌面骨预制体能达到颌面骨缺损的精确重建．有效地解决植入体塑形困难．简化了手术程序及缩短手术时间．且并发症少，效果良好，值得临床推广应用。

Application of composite artificial bone in the reconstruction of maxillofacial bone defects

Objective To evaluate the clinical application of individual artificial bone fabrication with computer-aided design and computer-aided manufacturing technology in the reconstruction of maxillofacial bone defects. Methods Six patients with maxillofacial bone defect were observed between March 2005 and August 2010, 4 underwent reconstruction of orbital wall defects, 1 underwent reconstruction of zygomatic bone and maxillary bone defects and 1 underwent repair of hemifaeial microsomia. All patients took preoperative computer tomography scan, then with computer-aided design software, rapid prototyping technology for artificial bone fabrication by manufacturers with composite materials, and series of procedures, finally got the three-dimensional maxillofaeial model and artificial bone fitted to the defects. Three patients combined with skin and soft tissue defects were repaired with skin flaps simultaneously or latterly. Results All fabrications could fixed to the defect areas quickly and precisely, and all wounds healed well without any complications, except one who healed by second intention with debridement and suturing which undergone intraoral incision and resulted in part of wound dehiscence. Conclusion With composite artificial bones and combined with computer-aided design and computer-aided manufacturing technology, reconstruction of maxillofacial bone defect can be obtained easily, quickly and effectively with good result and few complications.