Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. Siegmar Reinert, M.D., D.M.D., Ph.D.), University Hospital Tuebingen, Osianderstrasse 2-8, 72076, Tuebingen, Germany.
Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. Siegmar Reinert, M.D., D.M.D., Ph.D.), University Hospital Tuebingen, Osianderstrasse 2-8, 72076, Tuebingen, Germany.
J Craniomaxillofac Surg. 2018 Sep;46(9):1645-1651. doi: 10.1016/j.jcms.2018.05.047. Epub 2018 Jun 1.
The purpose of this study was to compare the three-dimensional accuracy of mandibular reconstruction following mandible continuity resection in patients treated with patient-specific, pre-bent reconstruction plates, using an 'in-house' 3D printer, with that in patients treated with conventional, intraoperatively bent plates.
We retrospectively analyzed 42 alloplastic mandibular reconstructions following continuity resection. 21 patients received patient-specific, pre-bent reconstruction plates using an in-house 3D printer. The control group consisted of 21 patients provided with intraoperatively bent reconstruction plates. Distances between corresponding anatomical landmarks on the mandibular angle and condyle (A-A', BB', CC', BC'), as well as the intercondylar angle (ICA), were measured and compared on the pre- and postoperative CT scans.
Multivariate analysis of variance (MANOVA) showed significant multivariate main effect of group (F = 5.58, p = 0.001; Wilks lambda 0.564; partial η = 0.436), indicating more accurate postoperative results for the pre-bent group. Post-hoc comparison revealed significantly larger postoperative deviation in the distances between the mandibular angle and the intercondylar angle (ICA) for the intraoperatively bent group in comparison with the pre-bent group. However, there was no significant effect on the distance between the condyles.
Mandibular reconstructions employing patient-specific, pre-bent reconstruction plates made using an in-house 3D printer show significantly better three-dimensional accuracy compared with intraoperatively bent plates. The described method prevents rotational error of the mandibular angle and improves restoration of the physiological intercondylar angle in mandible reconstruction after continuity resection.
本研究旨在比较使用内部 3D 打印机制作的患者特异性预弯重建板与术中弯曲的传统重建板治疗下颌骨连续性切除后下颌骨重建的三维精度。
我们回顾性分析了 42 例连续性切除后的全假体下颌骨重建。21 例患者接受了使用内部 3D 打印机的患者特异性预弯重建板治疗。对照组由 21 例接受术中弯曲重建板治疗的患者组成。在术前和术后 CT 扫描上测量并比较下颌角和髁突（A-A'、BB'、CC'、BC'）以及髁间角（ICA）的对应解剖标志之间的距离。
多元方差分析（MANOVA）显示组间存在显著的多元主效应（F=5.58，p=0.001；Wilks lambda 0.564；部分η=0.436），表明预弯组的术后结果更准确。事后比较显示，与预弯组相比，术中弯曲组下颌角与髁间角（ICA）之间的术后距离偏差明显更大。然而，在髁突之间的距离上没有显著影响。
使用内部 3D 打印机制作的患者特异性预弯重建板进行的下颌骨重建与术中弯曲的重建板相比，具有显著更好的三维精度。该方法可防止下颌角的旋转误差，并改善连续性切除后下颌骨重建中生理髁间角的恢复。
