【摘要】 目的探讨数字三维重建联合3D打印技术在血管化腓骨移植修复重建下颌骨缺损手术的术前规划、术中指导及医患沟通中的临床应用价值。方法选取下颌骨切除手术26例,其中包括口腔恶性肿瘤11例,下颌骨成釉细胞瘤7例,颌骨囊肿病变5例,下颌骨牙源性角化囊性瘤3例。所有病人术前均行头颅三维CT扫描,获得DICOM数据,行三维建模,重建出下颌骨三维数字模型,并转换为STL格式,通过激光快速3D成型打印机制作三维1:1实物模型。对下颌骨膨隆、变形、破坏者,通过镜像及修补技术进行数字三维重建,根据对侧下颌骨反求出患侧复原模型,3D打印出重建的镜像模型。术前应用3D打印模型与病人及其家属沟通并进行3D打印模型的效度验证。行下颌骨部分切除的病例,在3D打印原型上进行手术设计,制定手术方案,确定截骨线。在3D打印镜像模型上,进行移植腓骨的制备设计,对重建固定板进行术前精准预弯。按照术前手术模拟、规划实施手术,术后进行验证、评估及随访。结果术前应用3D模型获得了良好的沟通效果,病人及其家属理解度和满意度高。应用数字三维重建联合3D打印辅助手术规划,实际手术与模拟手术的效果一致,节省了术中弯制重建板的时间,使得移植腓骨与下颌骨断端精密接合,术后面型恢复良好。双层移植腓骨良好恢复了下颌骨高度,二期牙种植后恢复了颌面外观及咀嚼功能。结论数字三维重建联合3D打印能全方位、直观、精确地显示下颌骨的三维解剖结构以及病灶情况,对手术有极大的临床指导价值,实现下颌骨缺损的精准移植腓骨修复,获得了优良的临床效果,极大地提升了显微外科游离组织瓣修复重建的临床水平。更多还原

【Abstract】 Objective To investigate the clinical value of digital three-dimensional(3D)reconstruction combined with 3D printing in the preoperative planning,intraoperative guidance,and doctor-patient communication of the reconstruction of mandibular defects with vascularized fibula transplantation. Methods Twenty-six patients underwent mandibular resection due to oral malignant tumor(n=11),mandibular ameloblastoma(n=7),jaw cyst(n=5),and keratocystic odontogenic tumor(n=3).All patients underwent three-dimensional CT scans of the head before surgery.The DICOM data were obtained to reconstruct 3D digital model of the mandible and were converted to STL format to produce a 3D 1:1 physical model by laser rapid 3D model printer.For patients who had bulged,deformed or damaged mandible,digital 3D reconstruction was performed using mirroring and repair techniques.The reconstructed mirror model was 3D printed according to the contralateral mandible.Before surgery,the 3D printed mirror model was used to communicate with patients and their families and the validity of the 3D printed mirror model was validated.For patients undergoing partial mandibular resection,the 3D printed original model was used to design the surgery,develop surgical options,and identify the osteotomy line.The 3D printed mirror model was used to design the preparation of the graft fibula and perform preoperative precise pre-bending of the reconstruction plate.According to preoperative surgical simulation and planning,the surgery was performed and the validation,assessment,and follow-up were performed after surgery. Results The 3D model achieved a good communication effect with a high degree of understanding and satisfaction in patients and their families.The application of digital 3D reconstruction combined with 3D printing in surgery planning could produce the similar effect in actual and simulated surgery and save the time for bending the reconstruction plate,making precise engagement between the graft fibula and mandibular fracture ends and good postoperative surface recovery.Bilaterally transplanted fibula successfully restored the mandibular height and the maxillofacial appearance and masticatory function after the secondary dental implant. Conclusion Digital 3D reconstruction combined with 3D printing can fully,intuitively,and accurately display the three-dimensional anatomical structure and lesion status of the mandible.It has great clinical value for guiding surgery.It can achieve the precise reconstruction of mandibular defects with fibular transplantation,has a good clinical effect,and can greatly enhance the microsurgical free tissue flap repair and reconstruction in clinical practice.更多还原