摘要:
Objective To investigate the value of computer aided design and 3D printing model in operation for complex mandibular fractures.Methods The clinical data of 136 patients with complex mandibular fractures treated from June 2006 to June 2016 were retrospectively analyzed.The patients were divided into 3D group (n =28) and conventional group (n =108) based on the use of computer aided design and 3D printing model.There were 24 males and four females in 3D group,with the age of (33.8 ± 15.4) years.There were 91 males and 17 females in conventional group,with the age of (30.3± 11.9)years.The 3D group used computer aided design and 3D printing model to develop the surgical plan,and the conventional group used traditional CT scan image data.The operation time,intraoperative blood loss,incidence of postoperative adverse events,and the distance differences between the ipsilateral and the five contralateral maxillofacial markers were compared between the two groups (△L1:the difference between the mandibular angle point and the condyle apex;△L2:the difference between the mandibular angle point and the chin vertex;△L3:the difference between the apex of the chin and the apical point;△L4:the difference between the inner mandibular angle point and the Inferior alveolar margin point;△L5:the distance between the inner mandibular angle and the sagittal plane).Results The operation time in the 3D group and the conventional group were 155 (126.25,183.75)min and 235 (156.25,268.75)min,respectively.The intraoperative blood loss in the 3D group and the conventional group were 100 (50.0,187.5) ml and 125 (100.0,200.0) ml,respectively.In the 3D group,one patient had mild occlusion disorder.In the conventional group,4 patients had postoperative infection,1 repulsion reaction of internal fixation device,and 19 mild occlusion disorder.The differences between the two groups in operation time and postoperative adverse events were statistically significant (P < 0.05),but there was no significant difference in intraoperative blood loss (P > 0.05).There was no significant difference between the ipsilateral △L and contralateral △L in two groups (P > 0.05).No significant difference in △L4 was found (P > 0.05),but there were significant differences in △L1,△L2,△L3,and △L5 between the two groups (P <0.05).Conclusion For patients with complex mandibular fractures,the use of computer-aided design and 3D printing model can helps shorten operation time,reduce postoperative adverse events and hence improve the fracture reduction outcome.%目的 探讨计算机辅助设计及3D打印模型在复杂下颌骨骨折手术中的应用价值.方法 采用回顾性病例对照研究分析2006年6月—2016年6月手术治疗的136例复杂下颌骨骨折患者临床资料,根据是否使用计算机辅助设计及3D打印模型分为3D组和常规组.3D组28例,其中男24例,女4例;年龄(33.8±15.4)岁.常规组108例,其中男91例,女17例;年龄(30.3±11.9)岁.3D组采用计算机辅助设计及3D打印模型制订手术计划,常规组采用传统CT平扫影像资料制订手术计划.比较两组手术时间、术中出血量、术后不良事件发生率,以及患侧与健侧5个颌面部标志点距离差值(△L)(△L1为患侧与健侧下颌角点至髁顶点距离差值;△L2为患侧与健侧下颌角点至颏顶点距离差值;△L3为患侧与健侧颏顶点至髁顶点距离差值;△L4为患侧与健侧内下颌角点至下牙槽缘点距离差值;△L5为患侧与健侧内下颌角点至中矢状面距离差值).结果 3D组和常规组手术时间分别为155(126.25,183.75)min、235(156.25,268.75)min,术中出血量分别为100(50.0,187.5) ml,125(100.0,200.0) ml.3D组中1例出现轻度咬合关系紊乱;常规组中4例出现术后感染,1例内固定装置排斥反应,19例轻度咬合关系紊乱.两组手术时间、术后不良事件发生率差异有统计学意义(P<0.05),术中出血量差异无统计学意义(P>0.05).两组患者下颌骨健侧和术前患侧的5个线距测量值差异无统计学意义(P>0.05),两组△L4差异无统计学意义(P>0.05),△L1,△L2,△L3,△L5差异均有统计学意义(P<0.05). 结论 对于复杂下颌骨骨折患者,计算机辅助设计及3D打印模型的使用有助于缩短手术时间,降低术后不良事件发生率,提高骨折复位效果.