Zhang ShanYong, Liu XiuMing, Xu YuanJin, Yang Chi, Undt Gerhard, Chen MinJie, Haddad Majd S, Yun Bai
Department of Oral and Maxillofacial Surgery, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
J Oral Maxillofac Surg. 2011 Feb;69(2):432-8. doi: 10.1016/j.joms.2010.05.081. Epub 2010 Nov 20.
To introduce the preliminary application of rapid prototyping (RP) for temporomandibular joint (TMJ) surgery.
This study included 11 consecutive patients (13 joints) seeking TMJ replacement. All patients had previously undergone 3-dimensional computed tomography (CT) scanning (0.625-mm slice thickness) of the craniofacial skeleton. The data from CT scanning in DICOM (Digital Imaging and Communications in Medicine) format were input into the interactive Simplant CMF software program (Materialise Medical, Leuven, Belgium). Preoperative planning included segmentation and osteotomies. The movements of the jaw bones were simulated by use of Simplant CMF. The affected mandible was reconstructed based on the contralateral side. Then, the titanium plate was shaped on the reconstructed model before surgery. The bone graft was transplanted by the shaped titanium plate during the operation to reconstruct the TMJ. Twenty-four patients who underwent traditional surgery were used as the control group. The operative time of the 2 groups was analyzed with the SPSS software package, version 13.0 (SPSS, Chicago, IL), with the Student t test. The data from CT scanning in the experimental group before and after surgery were compared by paired t test.
All the incisions healed primarily without any complications. All patients were satisfied with the operation, because of their symmetric faces and good occlusion. Postoperative magnetic resonance imaging confirmed the position of the transplanted costochondral cartilage in the glenoid fossa. A group t test showed that the operative time was longer in the control group (mean, 7.09 hours) than that in the RP group (mean, 5.67 hours). Three parameters (condyle-incisor, condyle-mental foramen, and condyle-angle) from the postoperative CT scan were analyzed by paired t test, and there was no significant difference between the 2 sides.
RP technology provides an advanced method for TMJ reconstruction that can make the TMJ reconstruction more accurate and symmetric, improve the mandible's function, and consequently, enhance the reconstructive effect.
介绍快速成型（RP）技术在颞下颌关节（TMJ）手术中的初步应用。
本研究纳入了11例连续的寻求TMJ置换的患者（13个关节）。所有患者此前均接受了颅面骨骼的三维计算机断层扫描（CT）（层厚0.625毫米）。以医学数字成像和通信（DICOM）格式的CT扫描数据被输入到交互式Simplant CMF软件程序（Materialise Medical，比利时鲁汶）中。术前规划包括分割和截骨术。使用Simplant CMF模拟颌骨的运动。根据对侧重建患侧下颌骨。然后，在手术前在重建模型上对钛板进行塑形。术中通过塑形的钛板移植骨 graft 来重建TMJ。将24例行传统手术的患者作为对照组。使用SPSS软件包13.0版（SPSS，伊利诺伊州芝加哥）对两组的手术时间进行分析，采用Student t检验。通过配对t检验比较实验组手术前后CT扫描的数据。
所有切口均一期愈合，无任何并发症。所有患者对手术满意，因为面部对称且咬合良好。术后磁共振成像证实了移植的肋软骨在关节盂窝中的位置。成组t检验显示对照组的手术时间（平均7.09小时）比RP组（平均5.67小时）长。通过配对t检验分析术后CT扫描的三个参数（髁突-切牙、髁突-颏孔和髁突-角），两侧之间无显著差异。
RP技术为TMJ重建提供了一种先进的方法，可使TMJ重建更准确、对称，改善下颌骨功能，从而提高重建效果。
