【摘要】 背景:传统的颅骨缺损修复方法存在反复修整塑形时间长、术后效果取决于术者经验等弊端。计算机辅助设计与快速成型技术引入颅颌面外科,使颅骨缺损个体化三维仿真设计与修复成为可能。目的:拟利用CT数据、计算机辅助设计/与制造预制个体化钛合金修复体,探讨其对创伤后颅骨缺损的重建效果。方法:连续薄层扫描获得断层数据,在三维重建图像上设计修复体至外观形态满意,获得修复体的三维数据,将数据传输至快速成型机进行修复体的三维原型制造,最后利用医用钛合金铸造修复体。术中将修复体植入缺损区域,钛钉固定。共26例创伤后颅骨缺损患者运用该方法进行修复,缺损面积6cm×8cm～12cm×15cm。结果与结论:所有患者伤口1期愈合,修复体与缺损区域有良好的适配性,术中无需修正、固定即可。术后随访4年,修复体形态良好,无感染和修复体外露发生。提示计算机辅助设计/与制造预制个体化修复体重建创伤后颅骨能最大限度的恢复患者外形,术中无需再加工,缩短了手术时间,修复效果良好。更多还原

【Abstract】 BACKGROUND:Traditional method of cranioplasty has disadvantages such as modeling and shaping for long time in-operation,and the result depends on the experience of the performer. Since the computer aided design and rapid prototyping technology introducing to cranial maxillofacial surgery,the cranial defect reconstruction of individual design and 3-dimentional simulation become possible. OBJECTIVE:To evaluate the clinical efficacy of computer-aided design/computer-aided manufacturing of individual titanium implant in repairing post-traumatic cranial defect. METHODS:Data acquisition was performed by electron beam computed tomography,and data transferring was performed by on-line telecommunication systems to work-station,where the 3D geometric model of skull defect was established. A geometric shaped patch was designed by intellectual technology. The solid model by the rapid prototyping technique was made and the individual titanium implant was manufactured by casting. The routine surgical repair was performed. Total 26 patients who suffered from post-traumatic cranial defect were treated and cured. The defect area was ranged from 6 cm×8 cm to 12 cm×15 cm. RESULTS AND CONCLUSION:All wound healed primarily. Prosthetic replacement well matched defect. No correction or fixation was required in operation. During the followed up of 1-4 years,the appearances of cranium looked beautiful and symmetric,with no infection,or titanium plate exposed. Compared with the conventional manual cranioplasty,the individualized titanium implant prefabricated by computer-aided design/computer-aided manufacturing technique has many advantages,such as simple operation,natural curve similar to the shape of the original cranium,no need of intraoperative reshaping and few complications.更多还原