Khatib Baber, Couey Marcus, Patel Ashish, Cheng Allen, Bell R Bryan
Attending Head and Neck/ Microvascular Reconstructive Surgeon, Providence, Head and Neck Cancer Program, Providence Cancer Center, Portland, OR; Attending Maxillofacial Surgeon, Legacy Emanuel/Good Samaritan Medical Center, Portland, OR; Consultant Head and Neck Institute, Portland, OR.
Fellow in Head and Neck Oncologic and Reconstructive Microvascular Surgery/Immuno-oncology Providence, Head and Neck Cancer Program, Providence Cancer Center, Portland, OR.
J Oral Maxillofac Surg. 2022 Mar;80(3):559-568. doi: 10.1016/j.joms.2021.11.020. Epub 2021 Dec 4.
In computer surgical planned (CSP) fibular reconstructions of the mandible, custom plates facilitate accurate and efficient transfer of the digital plan intraoperatively by a way of predrilled fixation holes. Stock plates are more easily accessible and are more economical but typically preclude the utilization of these predictive holes. The purpose of this article is to describe an accurate and economical alternative to custom plates, while still having the ability to create predictive holes for plate alignment and execution of a digital surgical plan.
An in vitro accuracy study was performed on a point-of-care resin-printed predictive hole guide termed "prebent plate analog" (PPA). Twenty stock 2.0 reconstruction plates prebent against a 3-dimensional printed mandibular model reconstructed with a 2-piece fibula were used to fabricate 20 PPAs. The proximal and distal 4 holes of each prebent plate and corresponding PPA were assessed using a heat map overlay, measuring difference in millimeters between matching points of the predictive hole segments. The median distance from the points of reference in the PPA versus the prebent plate was calculated for each predictive hole position in addition to the average error of the PPA to the stock plate.
Eighteen PPAs were used for statistical analysis; 2 were damaged in transport. The mean error between the body (-0.265) and condylar segments (-0.116 mm) and mean difference in error between the proximal predictive holes (-0.124 mm) and distal predictive holes (-0.215 mm) on the PPA were not statistically different (P = .061, P = .314 general estimating equation regression, respectively). The mean error across the PPA predictive holes and corresponding holes of the prebent plates was -0.194 mm (P < .001, general estimating equation regression).
The PPA is a precise and accurate analog that faithfully replicates the position of proximal and distal components of a prebent stock plate, thereby allowing for predictive hole placement in lieu of a custom plate in fibula mandibular reconstruction cases.
在计算机辅助手术规划（CSP）的下颌骨腓骨重建中，定制钢板通过预制固定孔有助于在术中准确、高效地转换数字规划。成品钢板更容易获得且更经济，但通常无法利用这些预钻孔。本文的目的是描述一种既准确又经济的定制钢板替代方案，同时仍具备为钢板对齐和执行数字手术规划创建预钻孔的能力。
对一种床旁树脂打印的预钻孔导向器“预弯钢板模拟物”（PPA）进行体外准确性研究。使用20块根据用两段式腓骨重建的三维打印下颌骨模型预弯的2.0成品重建钢板制作20个PPA。使用热图叠加评估每个预弯钢板和相应PPA近端和远端的4个孔，测量预钻孔段匹配点之间的毫米差异。除了计算PPA相对于成品钢板的平均误差外，还计算每个预钻孔位置PPA与参考点之间的中位距离。
18个PPA用于统计分析；2个在运输过程中损坏。PPA上主体段（-0.265）和髁突段（-0.116 mm）之间的平均误差以及近端预钻孔（-0.124 mm）和远端预钻孔（-0.215 mm）之间的误差平均差异无统计学意义（分别为P = 0.061，P = 0.314，广义估计方程回归）。PPA预钻孔与预弯钢板相应孔的平均误差为-0.194 mm（P < 0.001，广义估计方程回归）。
PPA是一种精确的模拟物，能忠实地复制预弯成品钢板近端和远端部件的位置，从而在腓骨下颌骨重建病例中允许代替定制钢板进行预钻孔定位。
