Kang Sang-Hoon, Lee Jae-Won, Lim Se-Ho, Kim Yeon-Ho, Kim Moon-Key
Faculty, Department of Oral and Maxillofacial Surgery, National Health Insurance Service Ilsan Hospital, Goyang; Clinical Associate Professor, Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Republic of Korea.
Chief Resident, Department of Oral and Maxillofacial Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea.
J Oral Maxillofac Surg. 2014 Oct;72(10):2032-42. doi: 10.1016/j.joms.2014.03.002. Epub 2014 Mar 13.
Stereolithographic guidance, increasingly used in orthognathic surgery, has not been completely verified for genioplasty. This study compared the accuracy of manual measurement with that of a stereolithographic guide in vitro.
Thirty rapid prototype (RP) mandibular models (15 pairs) were included in the experimental (stereolithographic) and control (manual) groups (15 each). Surgical simulation was performed in the 2 groups by advancing the chin 5 mm and then vertically reducing the chin 5 mm using Mimics software. In the stereolithographic group, genioplasty was performed on mandibular RP models using a 3-dimensionally printed surgical guide based on surgical simulation results. In the control group, it was performed using an osteotomy line drawn according to simulation measurements. For the 2 groups, anterior horizontal transverse error and anterior and posterior vertical errors were compared, as were data from the osteotomized chin segment and the preoperative surgical simulation. Positional difference error was calculated and the differences were evaluated with t tests.
For advancement genioplasty, the absolute anterior transverse error value was 0.47 ± 0.35 (mean ± standard deviation) with the stereolithographic guide, less than with the manual method (0.77 ± 0.45; P = .001). For reduction genioplasty, the absolute anterior vertical error value was 0.27 ± 0.23 mm with the stereolithographic guide versus 0.58 ± 0.49 mm with the manual method (P < .001).
Use of a stereolithographic surgical guide increased accuracy, but the difference in mean error values between methods was only approximately 0.3 mm. The superior accuracy may not be compelling in favor of stereolithographic surgical guides.
立体光刻引导技术在正颌外科手术中的应用日益广泛，但在颏成形术中尚未得到充分验证。本研究在体外比较了手动测量与立体光刻引导的准确性。
将30个快速原型（RP）下颌模型（15对）纳入实验组（立体光刻组）和对照组（手动组），每组各15个。两组均使用Mimics软件进行手术模拟，先将下巴前移5mm，然后垂直缩短下巴5mm。在立体光刻组，根据手术模拟结果，使用三维打印的手术导板对下颌RP模型进行颏成形术。在对照组，根据模拟测量结果绘制截骨线进行手术。比较两组的前水平横向误差、前后垂直误差，以及截骨颏段和术前手术模拟的数据。计算位置差异误差，并采用t检验评估差异。
对于前移颏成形术，立体光刻引导下的绝对前横向误差值为0.47±0.35（平均值±标准差），小于手动方法（0.77±0.45；P = .001）。对于缩短颏成形术，立体光刻引导下的绝对前垂直误差值为0.27±0.23mm，而手动方法为0.58±0.49mm（P < .001）。
使用立体光刻手术导板可提高准确性，但两种方法的平均误差值差异仅约为0.3mm。这种较高的准确性可能并不足以有力地支持立体光刻手术导板的使用。
