上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2019, Vol. 39 ›› Issue (9): 1052-.doi: 10.3969/j.issn.1674-8115.2019.09.018

• 论著·临床研究 • 上一篇    下一篇

国产个性化金属高分子一体式全颞下颌关节假体的临床初步应用

陈旭卓 1*，毛懿 1*，郑吉驷 1，姜闻博 2，张善勇 1，陈科 3，杨驰 1   

  1. 1. 上海交通大学医学院附属第九人民医院口腔外科，上海 200011；2. 上海交通大学医学院附属第九人民医院 3D打印医学转化中心，上海 200011；3. 上海交通大学材料科学与工程学院，上海 200240
  • 出版日期:2019-09-28 发布日期:2019-11-02
  • 通讯作者: 张善勇，电子信箱：
  • 作者简介:陈旭卓（1994—），男，博士生；电子信箱： cxzzxcaa@126.com。毛懿（1994—），男，硕士生；电子信箱： 394736444@qq.com。*为共同第一作者。
  • 基金资助:
    上海市科委科技创新行动计划生物医药领域科技支撑项目（16441908800）；上海市卫生和计划生育委员会重点项目（201640001）；上海市申康项目（16CR3104B）；上海交通大学“转化医学交叉研究基金”重点项目（ZH2018ZDA13）；上海交通大学医学院转化医学创新基金（TM201812）；上海交通大学医学院附属第九人民医院滚雪球项目（GXQ201806）

Clinical application of Chinese customized TC4/UHMWPE connected total temporomandibular joint prostheses

CHEN Xu-zhuo1*, MAO Yi1*, ZHENG Ji-si1, JIANG Wen-bo2, ZHANG Shan-yong1, CHEN Ke3, YANG Chi1   

  1. 1. Department of Oral and Maxillofacial Surgery, Shanghai Ninth Peoples Hospital, Collage of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China; 2. Center of 3D-printing Translational Medicine, Shanghai Ninth Peoples Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China; 3. School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
  • Online:2019-09-28 Published:2019-11-02
  • Supported by:
    Foundation of Science and Technology Commission of Shanghai Municipality, 16441908800; Foundation of Shanghai Municipal Commission of Health and Family Planning, 201640001; Project of Shanghai Hospital Development Center, 16CR3104B; Research Fund of Medicine and Engineering of Shanghai Jiao Tong University, ZH2018ZDA13; Innovation Fund for Translational Medicine of Shanghai Jiao Tong University School of Medicine, TM201812; Snowball Project of Shanghai Ninth Peoples Hospital, Shanghai Jiao Tong University School of Medicine, GXQ201806）。

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摘要： 目的 ·介绍金属高分子一体式全颞下颌关节（ temporomandibular joint，TMJ）假体临床应用的标准化流程，并评估假体植入的精确性和临床效果。方法 ·纳入 8名患有终末期 TMJ疾病需要接受全关节置换的患者。术前获取患者的颅颌面 CT数据，导入 Mimics 18.0软件中设计个性化假体及数字化导板。分别利用 3D打印、搅拌摩擦焊接（ friction spot welding，FSW）和计算机辅助加工（computer-aided manufacture，CAM）制造并加工假体的不同组件。术后对假体植入的精确性和有效性进行详细评估。结果 ·在数字化导板和虚拟手术计划（ virtual surgical planning，VSP）的指导下，所有假体在手术过程中稳定就位并固定。术前术后的拟合结果显示，假体术后位置与术前设计吻合良好，全假体系统的平均偏差为 0.417 mm（范围： 0.279～ 0.561 mm）。所有患者术后均表现出良好的面部对称性，疼痛、功能和张口度等疗效指标均得到明显改善。结论 ·标准化流程的指导确保了国产个性化全 TMJ假体临床应用的精确性和有效性。

关键词: 颞下颌关节, 全颞下颌关节假体, 假体设计, 临床应用

Abstract:

Objective · To introduce a standardized workflow for clinical application of Chinese customized TC4/UHMWPE connected total temporomandibular joint (TMJ) prostheses, and to evaluate its accuracy and clinical effectiveness. Methods · Eight patients with the end stage TMJ diseases were included in this study. The computed tomography (CT) data for patients were obtained and transformed into the Mimics 18.0 software preoperatively for the designing of the prostheses and digital templates. Three-dimensional (3D) printing, friction spot welding (FSW) and computer-aided manufacture (CAM) were used to fabricate different components of the prostheses. The effectiveness of intraoperative application and the accuracy of merging results were evaluated postoperatively. Results · With the guidance of digital templates and virtual surgical planning (VSP), all the prostheses were placed smoothly and fixed stably during surgical procedures. The merging results showed that the prostheses position matched with the preoperative design well, with an mean deviation of 0.417 mm (range: 0.279 to 0.561 mm) for the whole prosthesis system. All the patients exhibited good facial symmetry and satisfactory improvement in pain, function and mouth opening postoperatively. Conclusion · The standardized workflow ensures the accuracy and efficiency in clinical application of Chinese customized total TMJ prostheses.

Key words: temporomandibular joint, total temporomandibular joint prostheses, prosthesis design, clinical application

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