3-D打印技术用于钛网修复全上颌骨缺损6例报道

中国口腔颌面外科杂志 ›› 2016, Vol. 14 ›› Issue (6): 562-566.

3-D打印技术用于钛网修复全上颌骨缺损6例报道

刘秉尧, 曹罡, 董震, 陈伟, 徐金科, 张森林

南京医科大学金陵医院南京军区南京总医院口腔科,江苏南京 210002

出版日期:2016-11-20 发布日期:2016-12-05
通讯作者: 张森林,E-mail:doczhangsl@126.com
作者简介:刘秉尧（1982-）,男,在读硕士研究生,主治医师,E-mail:lby820122@126.com

Outcomes of maxillary reconstruction after total maxillectomy using 3-D computer-assisted fabricated individual titanium mesh technique in 6 cases

LIU Bing-yao, CAO Gang, DONG Zhen, CHEN Wei, Xu Jin-ke, ZHANG Sen-lin

Department of Stomatology, Jinling Hospital, Nanjing Medical University; Nanjing General Hospital of Nanjing Military Command. Nanjing 210002, Jiangsu Province, China

Online:2016-11-20 Published:2016-12-05

摘要/Abstract

摘要： 目的探讨基于3-D打印技术制备的个体化钛网在修复全上颌骨缺损中的应用效果。方法对6例因上颌骨肿瘤拟进行上颌骨全切除的患者,根据术前CT扫描数据,应用镜像和反求及快速成型技术,3-D打印出患侧上颌骨的树脂模型;在此模型上对钛网进行塑形,制备出个体化钛网。采用Weber- Fergusson切口和上颌牙龈缘切口进行上颌骨全切除后,将个体化钛网植入缺损区,严密缝合面部和牙龈伤口。通过临床和CT检查,评价其颌面部外形与功能、眼球突度和眼眶容积的恢复情况及并发症情况。采用SPSS17.0软件包对数据进行t检验。结果所有病例手术顺利,预弯的钛网不需要术中再次塑形和修剪,植入的钛网与缺损周边骨床贴合紧密。术后随访4~12个月,经临床和CT检查未见肿瘤复发。颌面部外形恢复良好,两侧对称;无眼球内陷和复视,患侧眼眶容积和眼球突度与健侧相近,无显著差异（P>0.05）;2例开口轻度受限,1例上颌牙槽突部钛网小部分外露,均为术后放疗患者。结论应用3-D打印技术预成型的钛网适用于全上颌骨缺损的修复,能精确恢复眼眶的解剖形态和容积。

关键词: 3-D打印, 钛网, 上颌骨缺损

Abstract: PURPOSE: To evaluate the usefulness and clinical outcomes of reconstruction of maxillary class Ⅲ defect using 3-D computer-assisted fabricated individual titanium mesh technique. METHODS: This retrospective study included 6 patients with maxillary class Ⅲ defect after total maxillectomy performed from May 2014 to August 2015. A 3-dimensional individualized stereo maxillary model based on mirror images of the unaffected maxilla was obtained to fabricate an anatomically adapted titanium mesh using computer-assisted design and manufacturing. The individual titanium mesh was inserted into the maxillary class Ⅲ defect after total maxillectomy. The incidence of postoperative complications was evaluated and the postoperative globe projection and orbital volume were measured. SPSS 17.0 software package was used for statistical analysis. RESULTS: All patients were satisfied with their postoperative facial symmetry and did not develop diplopia or endophthalmos. The postoperative orbital volume was 26.53±0.73 mL on the affected side and 26.63±0.66 mL on the unaffected side (P=0.65), and the globe projection was 16.15±0.37 mm and 16.67±0.65 mm, respectively (P=0.07). Titanium mesh exposure was observed in 1 patient and mild limitation of mouth opening was observed in 2 patients who underwent postoperative radiotherapy. CONCLUSIONS: Reconstruction of maxillary class Ⅲ defect with individual titanium mesh fabricated using computer-assisted techniques can achieve successful clinical outcomes, preserving orbital volume and globe projection.

Key words: 3-dimensional printing, Titanium mesh, Maxillary defect

中图分类号:

R782.24

刘秉尧, 曹罡, 董震, 陈伟, 徐金科, 张森林. 3-D打印技术用于钛网修复全上颌骨缺损6例报道[J]. 中国口腔颌面外科杂志, 2016, 14(6): 562-566.

LIU Bing-yao, CAO Gang, DONG Zhen, CHEN Wei, Xu Jin-ke, ZHANG Sen-lin. Outcomes of maxillary reconstruction after total maxillectomy using 3-D computer-assisted fabricated individual titanium mesh technique in 6 cases[J]. China J Oral Maxillofac Surg, 2016, 14(6): 562-566.

参考文献

[1] Lenox ND, Kim DD. Maxillary reconstruction [J]. Oral Maxillofac Surg Clin North Am, 2013, 25(2): 215-222.
[2] 陈哲, 郑晓华, 谢宝君, 等. 不同年龄正常眼眶容积的CT测量 [J].中华眼科杂志, 2006, 42(3): 222-225.
[3] 安金刚, 张智勇, 张益. 非单纯性眼眶骨折眶腔容积改变与眼球内陷相关性研究方法初探基于CT图像数据的计算机辅助测量 [J]. 现代口腔医学杂志, 2006, 20(6): 561-563.
[4] Kreeft AM, Krap M, Wismeifer D, et al. Oral function after maxillectomy and reconstruction with an obturator [J]. Int J Oral Maxillofac Surg, 2012, 41(11): 1387-1392.
[5] Brown JS, Rogers SN, McNally DN, et al. A modified classification for maxillectomy defect[J]. Head Neck, 2000, 22(1): 17-26.
[6] Brown JS, Shaw RJ. Reconstruction of the maxilla and midface: introducing a new classification [J]. Lancet Oncol, 2010, 11(10): 1001-1008.
[7] Peng X, Mao C, Yu GY, et al. Maxillary reconstruction with the free fibula flap[J]. Plast Reconstr Surg, 2005, 115(6): 1562-1569.
[8] Brown JS, Jones DC, Summerwill A. Vascularized iliac crest with internal oblique muscle for immediate reconstruction after maxillectomy[J]. Br J Oral Maxillofac Surg, 2002, 40(3): 183-190.
[9] Shan XF, Chen HM, Liang J, et al. Surgical reconstruction of maxillary and mandibular defects using a printed titanium mesh [J]. J Oral Maxillofac Surg, 2015, 73(7): 1437.e1-e9.
[10] Motiee-Langroudi M, Harirchi I, Amali A, et al. Reconstruction of midface and orbital wall defects after maxillectomy and orbital content preservation with titanium mesh and fascia lata: 3-year follow-up [J]. J Oral Maxillofac Surg, 2015, 73(12): 2447.e1-e5.
[11] Lee KM, Park JU, Kwon ST, et al. Three-dimensional pre-bent titanium implant for concomitant orbital floor and medial wall fractures in an East asian population [J]. Arch Plast Surg, 2014, 41(5): 480-485.
[12] 张森林, 孟昭业, 董震, 等. 游离前臂皮瓣与钛网联合修复上颌骨缺损 [J]. 中国修复重建外科杂志, 2004, 18(6): 459-461.
[13] Shengwei H, Zhiyong W, Qingang H, et al. Combined use of an anterolateral thigh flap and rapid prototype modeling to reconstruct maxillary oncologic resections and midface defects [J]. J Craniofac Surg, 2014, 25(4): 1147-1149.