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是否可以不使用颌骨固定通过 3D 打印导板尝试骨折复位?

Can Fracture Reduction be Attempted Through a 3D-Printed Guide Template Without Maxillomandibular Fixation?

机构信息

Graduate Student, Department of Oral & Maxillofacial Surgery, Chonnam National University Hospital, Gwangju, Republic of Korea; Graduate Student, Department of Oral & Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Republic of Korea.

Clinical Associate Professor, Department of Oral & Maxillofacial Surgery, Gachon University Gil Medical Center, Incheon, Republic of Korea.

出版信息

J Oral Maxillofac Surg. 2023 Aug;81(8):1025-1032. doi: 10.1016/j.joms.2023.05.002. Epub 2023 May 6.

Abstract

BACKGROUND

Computer-aided design and manufacturing (CAD/CAM) is widely used in clinical practice. This technology may change existing methods for mandibular fracture management.

PURPOSE

The purpose of this in-vitro study was to determine if the reduction for mandibular symphysis fracture can be performed without maxillomandibular fixation (MMF) using 3-dimensional (3D)-printed template.

STUDY DESIGN, SETTING, AND SAMPLE: This in-vitro study was designed as a proof-of-concept. The sample was composed of 20 existing pairs of intraoral scan and computed tomography (CT) data. A mandibular model stereolithography (STL) file was created by merging the STL file obtained for the bimaxillary dentitions with the CT DICOM file, and this was set as the original model. Using the original model, a STL file of a fracture model of the mandibular symphysis was created using CAD. A template similar to a wafer or an implant guide was manufactured to restore original occlusion, and the mandibular fracture model was reduced and fixed using the 3D-printed template and wire. This was set as the experimental group. The 3D coordinate system error was measured at 6 landmarks and statistically compared using scan data between models of the groups.

PREDICTOR/EXPOSURE/INDEPENDENT VARIABLES: Reduction techniques with MMF or without MMF using guide template for mandibular fracture model.

MAIN OUTCOME VARIABLE(S): The 3D coordinate system error (mm).

COVARIATES

The position of landmarks.

ANALYSES

The Mann-Whitney U test, student's t-test, and the Kruskal-Wallis test were used to analyze the coordinate errors between the landmarks. A P value of < .05 was considered statistically significant.

RESULTS

The 3D error value of the control and experimental group were 1.06 ± 0.63 mm (range: 0.11 to 2.92 mm) and 0.96 ± 0.48 mm (range: 0.2 to 2.95 mm), respectively. There was no statistical difference between the control and experimental group. There was a statistically significant difference in the lower 2 and lower 3 landmarks compared to the upper 1 (P = .001 and .000, respectively) before and after the reduction in the experimental group.

CONCLUSION AND RELEVANCE

This study demonstrates that the reduction using a 3D-printed guide template for the mandibular symphysis fracture could be possible even without the MMF.

摘要

背景

计算机辅助设计和制造(CAD/CAM)在临床实践中得到了广泛应用。这项技术可能会改变下颌骨骨折管理的现有方法。

目的

本体外研究的目的是确定是否可以使用 3 维(3D)打印模板在不进行颌间固定(MMF)的情况下进行下颌正中骨折复位。

研究设计、地点和样本:本体外研究设计为概念验证。样本由 20 对现有的口腔内扫描和计算机断层扫描(CT)数据组成。通过合并用于双颌牙列的 STL 文件和 CT DICOM 文件,创建了下颌模型立体光刻(STL)文件,并将其设置为原始模型。使用原始模型,通过 CAD 创建下颌正中骨折模型的 STL 文件。制造类似于晶圆或植入物引导器的模板以恢复原始咬合,然后使用 3D 打印模板和金属丝对下颌骨折模型进行复位和固定。这被设置为实验组。使用组间模型的扫描数据,测量 6 个标志点的三维坐标系统误差,并进行统计学比较。

预测因子/暴露/独立变量:使用下颌骨折模型的 MMF 或无 MMF 引导模板进行复位技术。

主要观察指标

三维坐标系统误差(mm)。

协变量

标志点的位置。

分析

使用 Mann-Whitney U 检验、学生 t 检验和 Kruskal-Wallis 检验分析标志点之间的坐标误差。P 值<0.05 被认为具有统计学意义。

结果

对照组和实验组的三维误差值分别为 1.06±0.63mm(范围:0.11 至 2.92mm)和 0.96±0.48mm(范围:0.2 至 2.95mm)。对照组和实验组之间没有统计学差异。实验组在复位前后,下 2 和下 3 个标志点与上 1 个标志点相比,差异有统计学意义(P=0.001 和 P=0.000)。

结论和相关性

本研究表明,即使不使用 MMF,使用下颌正中骨折 3D 打印引导模板也可以实现复位。

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