Liu H H, Li Y F, Mu X D, Xiang L, Tan X Y, Hu M
Department of Oral and Maxillofacial Surgery, General Hospital of Chinese PLA, Beijing 100853, China.
Department of Stomatology, The Fourth Medical Center of PLA General Hospital, Beijing 100142, China.
Zhonghua Kou Qiang Yi Xue Za Zhi. 2021 Nov 9;56(11):1085-1091. doi: 10.3760/cma.j.cn112144-20210308-00104.
To explore the application of three-dimensional (3D) printing technology in oral and maxillofacial surgery, so as to optimize and standardize its design and application. From January 2010 to December 2020, 40 cases of mandibular tumor surgery (20 cases of conventional group and 20 cases of guide plate group), 20 cases of temporomandibular joint replacement surgery (10 cases of conventional group and 10 cases of guide plate group), 20 cases of malocclusion surgery (10 cases of conventional group and 10 cases of guide plate group), 20 cases of radioactive particle implantation surgery (10 cases of CT guided group and 10 cases of guide plate group) were analyzed. All patients in the guide plate group were scanned with spiral CT, and the 3D models of the jaw and the donor bone area were reconstruction. According to the purpose of surgical guide, the design and clinical application of osteotomy guide, in place forming guide and puncture positioning guide were analyzed respectively. The design time of guide plate, the performance and printing time of guide material, the sterilization method of guide and its influence on accuracy, and the influence of guide application on operation time and accuracy were analyzed. The design time of orthognathic guide plate was (2.9±1.8) d, and the design time of mandibular transplantation guide plate was (2.8±1.8) d, that of the temporomandibular joint replacement guide plate and the puncture guide plate was (2.2±0.3) and (0.9±0.3) d. The average printing time of the 40 maxilla model was (11.1±1.6) h, and that of the 40 mandible models was (2.6±0.4) h. The average printing time of the 40 sets of osteotomy and positioning guide plate was (2.5±0.8) h, and that of the 10 puncture positioning guide plate (1.1±0.4) h. The operation time of the conventional group was (6.99±1.10) and (6.02±0.55) h. In the CT guided group, the operation time was (1.91±0.55) h and (0.89±0.15). The operation time of mandible tumor operation and radioactive particle implantation in the guide plate group was less than that in the control group (<0.05), and there was no significant difference in the operation time of orthognathic surgery and joint replacement between the two groups (>0.05). The displacement distance of the mark points in the TMJ replacement and mandibular tumor operation guide group was less than that in the control group (<0.05), and the error of the guide plate in orthognathic operation and particle implantation operation was basically less than 1 mm. The application of the surgical guide plate made by 3D printing technology helps to complete the operation more safely, accurately and quickly, But its design, manufacture and disinfection still need to be further standardized and improved.
探讨三维（3D）打印技术在口腔颌面外科中的应用，以优化并规范其设计与应用。2010年1月至2020年12月，分析40例下颌肿瘤手术（传统组20例、导板组20例）、20例颞下颌关节置换手术（传统组10例、导板组10例）、20例错颌畸形手术（传统组10例、导板组10例）、20例放射性粒子植入手术（CT引导组10例、导板组10例）。导板组所有患者均行螺旋CT扫描，重建颌骨及供骨区的3D模型。根据手术导板目的，分别分析截骨导板、就位成型导板及穿刺定位导板的设计与临床应用。分析导板设计时间、导板材料性能及打印时间、导板消毒方法及其对精度的影响，以及导板应用对手术时间和精度的影响。正颌导板设计时间为（2.9±1.8）天，下颌移植导板设计时间为（2.8±1.8）天，颞下颌关节置换导板及穿刺导板设计时间分别为（2.2±0.3）天和（0.9±0.3）天。40个上颌模型平均打印时间为（11.1±1.6）小时，40个下颌模型平均打印时间为（2.6±0.4）小时。40套截骨定位导板平均打印时间为（2.5±0.8）小时，10套穿刺定位导板平均打印时间为（1.1±0.4）小时。传统组手术时间分别为（6.99±1.10）小时和（6.02±0.55）小时。CT引导组手术时间分别为（1.91±0.55）小时和（0.89±0.15）小时。导板组下颌肿瘤手术及放射性粒子植入手术时间短于对照组（<0.05），两组正颌手术及关节置换手术时间差异无统计学意义（>0.05）。颞下颌关节置换及下颌肿瘤手术导板组标记点位移距离小于对照组（<0.05），正颌手术及粒子植入手术导板误差基本小于1毫米。3D打印技术制作的手术导板有助于更安全、准确、快速地完成手术，但其设计、制造及消毒仍需进一步规范和改进。
