Scholz M, Eufinger H, Wehmöller M, Heuser L, Harders A
Klinik für Neurochirurgie, Institut für Radiologie und Nuklearmedizin der Ruhr-Universität Bochum.
Zentralbl Neurochir. 1997;58(3):105-10.
The reconstruction of craniofacial bone defects with intraoperatively modeled prosthesis restricts the choice of material and its biocompatibility and the prediction of the esthetic result. A prolonged duration of the surgical procedure and an increased stress on the patient are consequences. In contrast, modern industrial CAD/CAM-systems allow the prefabrication of titanium prosthesis: An individual computer-based 3D model of the bony defect is generated after acquisition, transfer and evaluation of helical CT data. Basing on these data the individual prosthesis-shape is designed using freeform surfaces geometries and fabricated by a numerically controlled milling machine. The conical margins of this prosthesis-geometry are generated by the borders of the defect with a minimal gap of 0.25 mm, and the surface contours by considering the non-affected neighbouring contours with a constant thickness of 1.5 mm. Individual osteosynthesis-microplates for fixation are integrated in design and manufacturing if screw-holes cannot be integrated in the thin margins of the implants. The radiological and clinical results of 17 patients after reconstruction of craniofacial bone defects with CAD/CAM titanium implants were good. Complications were not observed.
使用术中塑形假体修复颅面骨缺损限制了材料的选择及其生物相容性，也限制了美学效果的预测。其后果是手术时间延长，患者承受的压力增加。相比之下，现代工业CAD/CAM系统允许预制钛假体：在获取、传输和评估螺旋CT数据后，生成基于计算机的个体骨缺损三维模型。基于这些数据，使用自由曲面几何形状设计个体假体形状，并通过数控铣床制造。该假体几何形状的锥形边缘由缺损边界生成，最小间隙为0.25毫米，表面轮廓通过考虑未受影响的相邻轮廓生成，厚度恒定为1.5毫米。如果螺钉孔不能集成在植入物的薄边缘，则在设计和制造中集成用于固定的个体接骨微型钢板。17例使用CAD/CAM钛植入物修复颅面骨缺损的患者的放射学和临床结果良好。未观察到并发症。
