Pavlychuk Tetiana, Chernogorskyi Denis, Chepurnyi Yurii, Neff Andreas, Kopchak Andrii
Department of Stomatology, O.O. Bogomolets National Medical University, Kyiv, Ukraine.
Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg and Philipps University Marburg, Germany.
J Oral Biol Craniofac Res. 2020 Oct-Dec;10(4):608-614. doi: 10.1016/j.jobcr.2020.08.018. Epub 2020 Aug 27.
The aim of the present study was to improve the accuracy and reliability of ORIF in patients with condylar head fractures (CHFs) by developing a design for patient specific fixators, navigation and repositioning guides, as well as the algorithms of their clinical application.
14 patients with 16 CHFs were treated by ORIF with the use of CAD/CAM technology. After virtual reduction of the bony fragments, the appropriate length and diameter of the screws was chosen. In biomechanically unfavorable cases (type p) patient specific reinforcement plates were used together with the positional screws for reinforcement of the bone-fixator system. And in cases of severely comminuted fractures patient specific 3-D plate was applied.
The CT data, obtained immediately after the operation revealed the good anatomical reduction. Any deviations of the small fragments noted were near 1 mm in all cases. Postoperative clinical examination at 3 months follow up showed good occlusion and mouth opening not less than 3 cm in all patients. The lateral and anterior mobility of the mandible was restored with small limitations of protrusive mobility in 1 case. All the patients were satisfied with the outcomes.
The application of the CAD/CAM technologies and the new design of the surgical guides and patient specific reinforcement plates for CHFs helps to improve the accuracy and quality of fragments reduction and stability of fixation with minimal risks of intraoperative complications.
CAD/CAM technologies improve the clinical effectiveness of treatment patients with the CHFs.
本研究的目的是通过开发针对患者的固定器、导航和重新定位导向器的设计及其临床应用算法，提高髁突头部骨折（CHF）患者切开复位内固定术（ORIF）的准确性和可靠性。
14例患有16处CHF的患者采用CAD/CAM技术进行ORIF治疗。在对骨碎片进行虚拟复位后，选择合适的螺钉长度和直径。在生物力学上不利的病例（p型）中，使用针对患者的加固板与定位螺钉一起加强骨固定系统。对于严重粉碎性骨折的病例，应用针对患者的三维钢板。
术后立即获得的CT数据显示解剖复位良好。在所有病例中，发现的小碎片的任何偏差均接近1毫米。3个月随访时的术后临床检查显示，所有患者咬合良好，开口度不少于3厘米。1例患者下颌骨的侧向和前向活动度恢复，但前伸活动度有轻微受限。所有患者对结果均满意。
CAD/CAM技术以及针对CHF的手术导向器和患者特异性加固板的新设计有助于提高骨折碎片复位的准确性和质量以及固定的稳定性，同时将术中并发症的风险降至最低。
CAD/CAM技术提高了CHF患者的临床治疗效果。
