Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany; Berta-Ottenstein-Programme for Clinician Scientists, Faculty of Medicine, University of Freiburg, Germany.
Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.
J Craniomaxillofac Surg. 2019 Jun;47(6):951-958. doi: 10.1016/j.jcms.2019.03.008. Epub 2019 Mar 15.
There has been a shift toward surgical treatment of ZMC (zygomaticomaxillary complex) fractures with open reduction and subsequent fixation in the past decades. Anatomically preformed osteosynthesis plates, already used in the field of craniomaxillofacial surgery for the treatment of fractures of the mandible and the orbit, might be a suitable option for ZMC fractures as well.
A statistical shape model was created from 179 cranial CT scans. Based on this surface model, an anatomically preformed plate for the reduction and fixation of ZMC fractures was developed in 3 sizes (S, M, L). Virtual analysis of the accuracy of the plate was performed on a dataset consisting of 120 CT scans.
Within a determined tolerance range of 0-1.5 mm, analysis revealed a high accuracy of the plate in 70-87 % of the CT scans. The S-sized plate has the highest overall accuracy, whereas the L-sized plate has highest accuracy at the "base" region which is essential for the placement of the plate.
The newly developed plate can be placed via an intraoral approach and analysis of the plate has confirmed its accuracy to be sufficient to ensure an adequate fracture reduction and fixation. It thus might allow for a less extensive approach and less approaches/incisions necessary overall to reduce and fixate ZMC fractures.
在过去几十年中,对于颧骨复合体(ZMC)骨折的治疗已经从传统的保守治疗转变为切开复位内固定。解剖预成型接骨板已经在颌面外科领域中用于治疗下颌骨和眼眶骨折,对于 ZMC 骨折来说,也可能是一种合适的选择。
从 179 例头颅 CT 扫描中创建了一个统计形状模型。基于该表面模型,开发了三种尺寸(S、M、L)的解剖预成型 ZMC 骨折复位固定接骨板。通过包含 120 例 CT 扫描的数据集对板的准确性进行了虚拟分析。
在 0-1.5mm 的确定公差范围内,分析显示板在 70-87%的 CT 扫描中具有很高的准确性。S 型板的整体准确性最高,而 L 型板在“底座”区域的准确性最高,这对于放置板至关重要。
新开发的板可以通过口腔内入路进行放置,并且对板的分析证实其准确性足以确保充分的骨折复位和固定。因此,它可能允许采用更小范围的入路,总体上需要更少的入路/切口来复位和固定 ZMC 骨折。