虚拟重建及3D打印复合导板在经口气管插管复杂颌面部骨折复位中的应用

doi:10.13701/j.cnki.kqyxyj.2023.09.005

口腔医学研究 ›› 2023, Vol. 39 ›› Issue (9): 785-791.DOI: 10.13701/j.cnki.kqyxyj.2023.09.005

虚拟重建及3D打印复合导板在经口气管插管复杂颌面部骨折复位中的应用

顾徐嘉¹, 孟箭^1,2, 李志萍^2,3*

1.徐州医科大学口腔医学院江苏徐州 221000;
2.徐州市中心医院口腔科江苏徐州 221000;
3.徐州医科大学徐州临床医学院江苏徐州 221000

收稿日期:2023-06-14 出版日期:2023-09-28 发布日期:2023-09-25
通讯作者: *李志萍,E-mail:jslzp@163.com
作者简介:顾徐嘉(1997~ ),男,江苏苏州人,住院医师,硕士在读,研究方向:数字化技术在颌面外科中的应用。
基金资助:
江苏省研究生科研与实践创新计划项目(编号:SJCX22_1290)

Application of 3D Printed Composite Guide Plate in Assisting the Reduction of Complex Maxillofacial Fractures under Oral Intubation General Anesthesia

GU Xujia¹, MENG Jian^1,2, LI Zhiping^2,3*

1. Stomatology School of Xuzhou Medical University, Xuzhou 221000, China;
2. Department of Stomatology, Xuzhou Centra Hospital, Xuzhou 221000, China;
3. Xuzhou Clinical College, Xuzhou Medical University, Xuzhou 221000, China

Received:2023-06-14 Online:2023-09-28 Published:2023-09-25

摘要/Abstract

摘要： 目的: 探讨个性化设计3D打印复合骨折复位导板在经口插管全身麻醉下辅助颌面部复杂骨折复位手术的临床效果。方法: 选择21例2021年10月~2023年6月就诊于徐州市中心医院颌面部复杂骨折的患者,随机分为3D打印导板组(实验组)10例,传统手法复位组(对照组)11例进行手术,术后进行色谱图评价、临床评价及选取颌骨解剖标志点进行对称性评价。结果: 实验组较对照组节省手术时间平均约40 min,术后3月复查均未发生相关并发症,对照组1例患者仍存在咬合错乱。实验组色谱图分析显示与术前虚拟手术模型的平均偏差度和最大偏差度的均值分别为(0.13±0.97) mm和(2.72±0.99) mm,显著小于对照组的(0.32±0.23) mm及(3.91±1.02) mm(P<0.05)。面下1/3对称性分析表明实验组要显著优于对照组(P<0.05),使用导板辅助手术能更精确达到术前预期(P<0.05)。结论: 采用个性化设计3D打印复合导板能辅助手术医生在经口插管全身麻醉条件下快速重建咬合,缩短手术时间,进行骨折段精准复位。

关键词: 3D打印, 骨折复位导板, 气管插管, 颌面部复杂骨折, 数字化

Abstract: Objective: To explore the clinical effect of personalized designed 3D printed composite guide plates in assisting reduction of complex maxillofacial fracture surgery under oral intubation general anesthesia. Methods: Twenty-one patients with complex maxillofacial fractures who were treated at Xuzhou Central Hospital from October 2021 to June 2023 were randomly divided into 3D printed guide plate group (experimental group, 10 cases) and traditional manual reduction group (control group, 11 cases). After surgery, chromatogram evaluation, clinical evaluation, and symmetry evaluation of jaw anatomical landmarks were performed. Results: The experimental group saved an average of about 40 minutes in contrast to the control group, and no related complications occurred after 3 months of follow-up. One patient in the control group still had malocclusion. The chromatogram analysis of the experimental group showed that the mean and maximum deviations from the preoperative virtual surgery model were (0.13±0.97) mm and (2.72±0.99) mm, which were significantly lower than those of control group (0.32±0.23) mm and (3.91±1.02) mm, (P<0.05). The symmetry analysis showed that the experimental group was significantly better than the control group (P<0.05), and the use of guide plate assisted surgery achieved more accurate preoperative expectations (P<0.05). Conclusion: The use of personalized 3D printed composite guide plates can assist surgeons in quickly finding occlusions under oral intubation general anesthesia, shorten surgical time, and achieve precise reduction of fracture segments.

Key words: 3D printing, fracture reduction guide plate, tracheal intubation, complex maxillofacial fractures, digital

顾徐嘉, 孟箭, 李志萍. 虚拟重建及3D打印复合导板在经口气管插管复杂颌面部骨折复位中的应用[J]. 口腔医学研究, 2023, 39(9): 785-791.

GU Xujia, MENG Jian, LI Zhiping. Application of 3D Printed Composite Guide Plate in Assisting the Reduction of Complex Maxillofacial Fractures under Oral Intubation General Anesthesia[J]. Journal of Oral Science Research, 2023, 39(9): 785-791.

参考文献

[1] Wusiman P, Maimaitituerxun B, Guli, et al. Epidemiology and pattern of oral and maxillofacial trauma [J]. J Craniofac Surg, 2020, 31(5):e517-e520.
[2] Kubat GO, Sahin C, Ozen O. Association of frontal and maxillary bone fractures and concomitant craniocerebral injuries in patients presenting with head trauma [J]. Niger J Clin Pract, 2022, 25(3):342-348.
[3] 张莉,刘华,岳万远,等.内镜下口底-颌下径路气管内插管麻醉在颅面部多发性骨折手术中的应用[J].实用口腔医学杂志,2017,33(2):208-210.
[4] 王永功,候明,王买全,等.经颌下置管全麻在复杂全面部骨折中的应用[J].口腔医学研究,2012,28(11):1153-1155,1159.
[5] 王玉洁,续飞,邹士琦,等.颌面部多发骨折合并颅底骨折行颏下径路气管插管1例[J].中国微创外科杂志,2019,19(5):470-472.
[6] Abreu ME, Viegas VN, Ibrahim D, et al. Treatment of comminuted mandibular fractures: a critical review [J]. Med Oral Patol Oral Cir Bucal, 2009, 14(5):E247-E251.
[7] Pickrell BB, Serebrakian AT, Maricevich RS. Mandible fractures [J]. Semin Plast Surg, 2017, 31(2):100-107.
[8] 蔡志刚.数字化外科技术在颅颌面修复重建中的应用及进展[J].中华整形外科杂志,2022,38(1):1-8.
[9] Tian Y, Chen C, Xu X, et al. A review of 3D printing in dentistry: Technologies, affecting factors, and applications [J]. Scanning, 2021, 2021:9950131.
[10] Chew KY, Kok YO, Pek WS, et al. Surgical planning using facial fracture 3D models: The role of cyanoacrylate glue and miniplating for anatomical reduction [J]. JPRAS Open, 2021, 28:19-24.
[11] King BJ, Park EP, Christensen BJ, et al. On-site 3-dimensional printing and preoperative adaptation decrease operative time for mandibular fracture repair [J]. J Oral Maxillofac Surg, 2018, 76(9):1950.e1-1950.e8.
[12] Alagarsamy R, Lal B, Sagar S, et al. Digital workflow for treating comminuted anterior mandibular fracture-A technical note [J]. J Stomatol Oral Maxillofac Surg, 2021, 122(4):453-455.
[13] Zhao L, Zhang X, Guo Z, et al. Use of modified 3D digital surgical guides in the treatment of complex mandibular fractures [J]. J Craniomaxillofac Surg, 2021, 49(4):282-291.
[14] Ren J, Zhou Z, Li P, et al. Three-dimensional planning in maxillofacial fracture surgery: Computer-aided design/computer-aided manufacture surgical splints by integrating cone beam computerized tomography images into multislice computerized tomography images [J]. J Craniofac Surg, 2016, 27(6):1415-1419.
[15] 陆友正,王志勇,席洪,等.导板外科应用于下颌骨粉碎性骨折精准复位[J].口腔医学,2019,39(8):714-718.
[16] Tondin GM, Leal MOCD, Costa ST,et al. Evaluation of the accuracy of virtual planning in bimaxillary orthognathic surgery: a systematic review [J]. Br J Oral Maxillofac Surg, 2022, 60(4):412-421.
[17] Ding Q, Fu ZZ, Yue J, et al. Virtual surgical planning and three-dimensional printing to aid the anatomical reduction of an old malunited fracture of the mandible [J]. J Craniofac Surg, 2021, 32(7):e647-e649.
[18] 吕继连,钟克涛,叶克强,等.3D打印辅助口内入路精准治疗下颌骨粉碎性骨折[J].实用医学杂志,2020,36(17):2339-2343.
[19] Bilal Y, Rahim AU, Gul SM, et al. Outcomes of extra oral versus intraoral approach for Mandibular angle fracture reduction [J]. J Pak Med Assoc, 2020, 70(12(A)):2088-2091.
[20] Lu R, Huang J, Zuo L, et al. Computer-assisted intraoral approach in the management of infected comminuted mandibular fractures: Technical notes [J]. J Stomatol Oral Maxillofac Surg, 2022, 123(6):634-638.
[21] Sukegawa S, Masui M, Kanno T, et al. Evaluation of open reduction and internal fixation of mandibular condyle fracture by intraoperative cone-beam computed tomography in a hybrid operating room [J]. J Craniofac Surg, 2020, 31(3):762-765.
[22] Zhou T, Li J, Chen S, et al. Application of computer-aided design and individualized templates for bilateral zygomaticomaxillary complex fractures [J]. J Craniofac Surg, 2022, 33(4):1230-1235.
[23] Xu G, Zhang X, Wang P, et al. Application of optimized three-dimensional digital surgical guide plates for complex midfacial fractures [J]. Injury, 2022, 53(6):2005-2015.
[24] 朱应超,于洪波.数字化技术在颧骨复合体骨折中的应用进展[J].口腔颌面外科杂志,2019,29(5):295-300.
[25] Ma J, Ma L, Wang Z, et al. The use of 3D-printed titanium mesh tray in treating complex comminuted mandibular fractures: A case report [J]. Medicine (Baltimore), 2017, 96(27):e7250.
[26] Dai J, Shen G, Yuan H, et al. Titanium mesh shaping and fixation for the treatment of comminuted mandibular fractures [J]. J Oral Maxillofac Surg, 2016, 74(2):337.e1-337.e11.

虚拟重建及3D打印复合导板在经口气管插管复杂颌面部骨折复位中的应用

Application of 3D Printed Composite Guide Plate in Assisting the Reduction of Complex Maxillofacial Fractures under Oral Intubation General Anesthesia

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