Eufinger H, Wehmöller M, Machtens E, Heuser L, Harders A, Kruse D
Department of Oral and Maxillofacial Surgery, Regional Plastic Surgery, Knappschaftskrankenhaus, University Hospital Bochum, Germany.
J Craniomaxillofac Surg. 1995 Jun;23(3):175-81. doi: 10.1016/s1010-5182(05)80007-1.
Reconstruction of craniofacial bone defects by intraoperative modelling of autogenous or alloplastic materials may cause undesirable results concerning the implant shape or the long-term maintenance of this shape. Furthermore, the use of alloplastic materials to be modelled intraoperatively may result in an inflammatory tissue response. Therefore the question is raised whether CAD/CAM-techniques may be used for the pre-operative geometric modelling of the implant based on helical computed tomography data. A numerically based 3-dimensional model of the skull defect serves as the basis for a freeform-surfaces design of the implant shape, position and thickness, using modelling tools and programmes developed for industrial CAD/CAM. The precise and individual fit of the implant results from generating its margins by the borders of the defect, whereas the implant surface is generated by the geometry of the non-affected neighbouring bone contours. The implant data run a numerically controlled milling machine to fabricate the individual implant. The reconstruction of post-traumatic defects of the forehead, of post-surgical temporal defects after intracranial haemorrhage, and of a parieto-occipital defect due to ablative tumour surgery are presented as the first clinical experiences of this new method.
通过对自体材料或异体材料进行术中塑形来重建颅面骨缺损，可能会在植入物形状或该形状的长期维持方面产生不理想的结果。此外，术中使用异体材料进行塑形可能会引发炎症组织反应。因此，人们提出了一个问题，即计算机辅助设计/计算机辅助制造（CAD/CAM）技术是否可用于基于螺旋计算机断层扫描数据对植入物进行术前几何建模。基于数值的颅骨缺损三维模型，作为使用为工业CAD/CAM开发的建模工具和程序对植入物形状、位置和厚度进行自由曲面设计的基础。植入物精确且个性化的贴合是通过根据缺损边界生成其边缘而实现的，而植入物表面则由未受影响的相邻骨轮廓的几何形状生成。植入物数据输入数控铣床以制造个性化植入物。本文展示了前额创伤后缺损、颅内出血后手术颞部缺损以及因肿瘤切除手术导致的顶枕部缺损的重建，作为这种新方法的首批临床经验。
