Numajiri Toshiaki, Nakamura Hiroko, Sowa Yoshihiro, Nishino Kenichi
Department of Plastic and Reconstructive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Plast Reconstr Surg Glob Open. 2016 Jul 15;4(7):e805. doi: 10.1097/GOX.0000000000000682. eCollection 2016 Jul.
Surgical cutting guides are used in mandibular reconstruction involving osteotomy of the mandible and fibula. Cutting guides produced using computer-aided design (CAD) and computer-aided manufacturing (CAM) technologies have been reported recently. These guides aim to increase the benefits to patients by improving the accuracy, shortening the operating time, and correcting occlusion. However, the availability of these advanced technologies is limited in some regions of the world. To test whether we could produce low-cost surgical cutting guides, we made surgical guides and investigated their accuracy.
Using free CAD software, we designed surgical cutting guides for the mandible and fibula and used these to perform virtual mandibular segmental osteotomies and fibula transplants in 12 model surgeries. The cutting guides were printed on a 3-dimensional (3D) printer. The model surgeries were performed using 3D mandibular models and cutting guides to check their accuracy. Deviations between the virtually simulated plan and the actual model surgery were investigated.
CAD and CAM technologies were used to design and 3D print the cutting guides and models. The guided surgeries were performed. The deviations were about 1.3 mm for mandibular osteotomy, less than 1 mm for fibular osteotomy, and within 2.4 mm for reconstructions of the mandible.
Without using expensive software or products, we were able to design surgical cutting guides for the mandible and fibula and used these to perform virtual simulation of mandibular segmental osteotomy and fibular reconstruction. Model surgeries using 3D-printed surgical guides showed that the accuracy of reconstruction was within a 3-mm deviation. In circumstances where commercial CAD/CAM guides are not available, it may be possible to use CAD/CAM surgical guides in the clinic if doctors are willing to volunteer their time for the design and printing.
手术切割导板用于涉及下颌骨和腓骨截骨术的下颌骨重建。最近有报道称使用计算机辅助设计（CAD）和计算机辅助制造（CAM）技术生产的切割导板。这些导板旨在通过提高准确性、缩短手术时间和矫正咬合来增加对患者的益处。然而，这些先进技术在世界上一些地区的可用性有限。为了测试我们是否能够生产低成本的手术切割导板，我们制作了手术导板并研究了它们的准确性。
使用免费的CAD软件，我们设计了下颌骨和腓骨的手术切割导板，并在12次模型手术中使用这些导板进行虚拟下颌骨节段性截骨术和腓骨移植。切割导板在三维（3D）打印机上打印。使用3D下颌骨模型和切割导板进行模型手术以检查其准确性。研究了虚拟模拟计划与实际模型手术之间的偏差。
使用CAD和CAM技术设计并3D打印了切割导板和模型。进行了导板引导的手术。下颌骨截骨术的偏差约为1.3毫米，腓骨截骨术的偏差小于1毫米，下颌骨重建的偏差在2.4毫米以内。
无需使用昂贵的软件或产品，我们能够设计下颌骨和腓骨的手术切割导板，并使用这些导板进行下颌骨节段性截骨术和腓骨重建的虚拟模拟。使用3D打印手术导板的模型手术表明，重建的准确性偏差在3毫米以内。在没有商业CAD/CAM导板的情况下，如果医生愿意自愿花时间进行设计和打印，临床上可能可以使用CAD/CAM手术导板。
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