3D打印导板在上颌骨前段牵引成骨中的应用及精度测量

doi:10.3969/j.issn.1674-8115.2024.01.005

上海交通大学学报（医学版） ›› 2024, Vol. 44 ›› Issue (1): 43-49.doi: 10.3969/j.issn.1674-8115.2024.01.005

3D打印导板在上颌骨前段牵引成骨中的应用及精度测量

万腾(), 姜腾飞, 朱敏, 王旭东()

上海交通大学医学院附属第九人民医院口腔颅颌面科，上海交通大学口腔医学院，国家口腔医学中心，国家口腔疾病临床医学研究中心，上海市口腔医学重点实验室，上海市口腔医学研究所，中国医学科学院口腔颌面再生医学创新单元，上海 200011

收稿日期:2023-05-30 接受日期:2023-10-25 出版日期:2024-01-28 发布日期:2024-02-28
通讯作者: 王旭东 E-mail:wonton1984@gmail.com;xudongwang70@hotmail.com
作者简介:万腾（1984—），男，主治医师，硕士；电子信箱：wonton1984@gmail.com。
基金资助:
国家重点研发计划(2023YFC2414100);国家自然科学基金(82370905);上海市口腔-颅颌面数字化技术研发与应用专业服务平台(21DZ2294600);国家临床重点专科建设项目(Z155080000004);上海市重中之重研究中心(2022ZZ01017);中国医学科学院医学与健康科技创新工程项目(2019-12M-5-037);上海交通大学医学院“双百人”项目(20152225)

Application and accuracy assessment of a novel 3D-printed osteotomy guide in anterior maxillary segmental distraction osteogenesis

WAN Teng(), JIANG Tengfei, ZHU Min, WANG Xudong()

Department of Oral & Cranio-Maxillofacial Surgery, Shanghai Ninth People′s Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology; Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai 200011, China

Received:2023-05-30 Accepted:2023-10-25 Online:2024-01-28 Published:2024-02-28
Contact: WANG Xudong E-mail:wonton1984@gmail.com;xudongwang70@hotmail.com
Supported by:
National Key R&D Program of China(2023YFC2414100);National Natural Science Foundation of China(82370905);Shanghai Professional Service Platform of Oral-Cranio-Maxillofacial Digital Technology Research and Application(21DZ2294600);National Clinical Key Specialty(Z155080000004);Shanghai′s Top Priority Research Center(2022ZZ01017);CAMS Innovation Fund for Medical Sciences(2019-I2M-5-037);"Two-hundred Talents" Program of Shanghai Jiao Tong University School of Medicine(20152225)

摘要/Abstract

摘要：

目的·评估上颌骨前段牵引成骨（anterior maxillary segmental distraction osteogenesis，AMSDO）在治疗唇腭裂继发上颌骨发育不足中的作用以及3D打印导板在截骨中的精度。方法·收集12例接受了AMSDO治疗的唇腭裂患者的病例资料。手术前在患者的三维模型上进行虚拟手术，并通过3D打印将患者的截骨线制成牙支持式导板。术前（T0）、巩固期结束（T1）以及巩固期后6个月（T2）进行头影测量以评估AMSDO的效果及稳定性。导板的精度通过术后即刻CT与术前设计CT进行叠加，并通过计算位置和角度误差进行评估。结果·所有患者都顺利完成了牵引治疗，没有发生严重的并发症。SNA（S-N-A角）和覆盖从T0到T1以及T0到T2都发生了显著的改变。ANB（A-N-B角）、面部突度、硬腭长度都发生了变化，但是差异没有统计学意义。SNB（S-N-B角）基本没有发生变化。从T1到T2，所有的参数都没有发生明显变化。导板截骨精度在矢状向的线性均方根误差为0.90 mm，角度均方根误差为5.07°。结论·AMSDO是治疗唇腭裂继发上颌骨发育不足的一种有效方法。3D打印的截骨导板具有良好的精度，在减少手术并发症的同时降低了手术的难度。

关键词: 上颌骨前段牵引成骨, 唇腭裂, 3D打印, 截骨导板, 上颌骨发育不良

Abstract:

Objective ·To evaluate the effects of anterior maxillary segmental distraction osteogenesis (AMSDO) in treating sagittal maxillary hypoplasia in cleft lip and palate (CLP) patients and to report a 3D-printed surgical guide to facilitate the osteotomy. Methods ·Twelve patients with CLP who underwent AMSDO were included in this study. Virtual osteotomy was performed in a 3-dimensional model and the osteotomy line were fabricated into a tooth-borne surgical guide by using 3D-printing technique. Lateral cephalograms taken before surgery (T0), at the end of consolidation (T1) and six months after consolidation (T2) were used to evaluate the effects of AMSDO. The accuracy of the osteotomy guide was measured by superimposing the postoperative CT data to virtual planning. Results ·All the patients went through surgery without serious complications. SNA and overjet changed significantly both from T0 to T1 and from T0 to T2. ANB, facial convexity, and palatal length changed without significance from T0 to T1 and from T0 to T2. SNB remained stable. All the variables remained relatively stable from T1 to T2. The anteroposterior linear root-mean-square deviation (RMSD) between planning and actual results was 0.90 mm, while the angular RMSD in the sagittal plane was 5.07°. Conclusion ·AMSDO is an effective treatment for maxillary hypoplasia secondary to CLP. The accuracy of this 3D-printed osteotomy guide is clinically acceptable, and this can simplify the surgery with fewer complications.

Key words: anterior maxillary segmental distraction osteogenesis (AMSDO), cleft lip and palate (CLP), 3D printing, osteotomy guide, maxillary hypoplasia

中图分类号:

R782.2

万腾, 姜腾飞, 朱敏, 王旭东. 3D打印导板在上颌骨前段牵引成骨中的应用及精度测量[J]. 上海交通大学学报（医学版）, 2024, 44(1): 43-49.

WAN Teng, JIANG Tengfei, ZHU Min, WANG Xudong. Application and accuracy assessment of a novel 3D-printed osteotomy guide in anterior maxillary segmental distraction osteogenesis[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(1): 43-49.

图/表 7

图1 截骨线的设计Note： The osteotomy lines were designed to avoid adjacent tooth roots and descending palatine artery.

Fig 1 Design of the osteotomy line

图2 分离上颌骨前部及后部骨块Note： The maxilla was separated into anterior segment (blue) and posterior segment (yellow).

Fig 2 Separation of the anterior and posterior segments of the maxilla

图3 设计截骨导板Note： The osteotomy guide was designed in Geomagic Studio 2013 and Geomagic Spark 2013. The edge of the osteotomy line was raised by 5 mm to determine the direction of the blade.

Fig 3 Design of the osteotomy guide

图4 术中用截骨导板辅助截骨Note： The osteotomy guide was fixed to the maxilla with mini screws. Piezosurgery and osteotome were used to finish the osteotomy.

Fig 4 Application of osteotomy guide during surgery

图5 2种牙支持式牵引器Note： A. Palatal tooth-borne distractor. B. Bilateral buccal tooth-borne distractor.

Fig 5 Two types of tooth-borne distractors

图6 实际截骨结果与术前设计进行匹配Note： The actual postoperative result (blue) was superimposed to the virtual planning (white). The anterior segment of the virtual planning was hidden to make the designed osteotomy line more visible.

Fig 6 Superimposition of the actual result with virtual planning

表2 术前设计与术后实际截骨线的位置与角度差异（n=9）

Tab 2 Positional and angular differences between the planned and post-operative outcomes （n=9）

Parameter	RMSD	x±s
Horizontal/mm	0.65	0.54±0.37
Sagittal/mm	0.90	0.71±0.57
Vertical/mm	1.18	1.01±0.62
X-Y plane/(°)	14.87	-5.03±14.4
X-Z plane/(°)	4.19	0.17±4.31
Y-Z plane /(°)	5.07	0.99±5.11

参考文献 16

1	WANG M, YUAN Y, WANG Z, et al. Prevalence of orofacial clefts among live births in China: a systematic review and meta-analysis: prevalence of oral clefts in China[J]. Birth Defects Res, 2017, 109(13): 1011-1019.
2	CAPELOZZA FILHO L, NORMANDO A D, DA SILVA FILHO O G. Isolated influences of lip and palate surgery on facial growth: comparison of operated and unoperated male adults with UCLP[J]. Cleft Palate Cran J, 1996, 33(1): 51-56.
3	CHEUNG L K, CHUA H D P, Hägg M B. Cleft maxillary distraction versus orthognathic surgery: clinical morbidities and surgical relapse[J]. Plast Reconstr Surg, 2006, 118(4): 996-1008.
4	张继生, 唐友盛, 卢晓峰, 等. 上颌骨牵引成骨对腭咽闭合功能的影响[J]. 临床口腔医学杂志, 2004, 20(3): 168-170.
	ZHANG J S, TANG Y S, LU X F.Effects of maxillary DO on velopharyngeal function[J]. Journal of Clinical Stomatology, 2004, 20(3): 168-170.
5	YU H, WANG X, FANG B, et al. Comparative study of different osteotomy modalities in maxillary distraction osteogenesis for cleft lip and palate[J]. J Oral Maxillofac Surg, 2012, 70(11): 2641-2647.
6	RICHARDSON S, SELVARAJ D, KHANDEPARKER R V, et al. Tooth-borne anterior maxillary distraction for cleft maxillary hypoplasia: our experience with 147 patients[J]. J Oral Maxillofac Surg, 2016, 74(12): 2504.e1-2504.e14.
7	LIU X, CHEN Z. Effects of palate repair on cranial base and maxillary morphology in patients with unilateral complete cleft lip and palate[J]. Cleft Palate Craniofac J, 2018, 55(10): 1367-1374.
8	SALGADO K R, WENDT A R, FERNANDES FAGUNDES N C, et al. Early or delayed palatoplasty in complete unilateral cleft lip and palate patients? A systematic review of the effects on maxillary growth[J]. J Craniomaxillofac Surg, 2019, 47(11): 1690-1698.
9	KAPPEN I F P M, YODER W R, MINK VAN DER MOLEN A B, et al. Long-term craniofacial morphology in young adults treated for a non-syndromal UCLP: a systematic review[J]. J Plast Reconstr Aesthet Surg, 2018, 71(4): 504-517.
10	MCCARTHY J G, SCHREIBER J, KARP N, et al. Lengthening the human mandible by gradual distraction[J]. Plast Reconstr Surg, 1992, 89(1): 1-8; discussion9-10.
11	刘庆成, 王敏娇, 司家文, 等. 前段截骨牵引治疗唇腭裂继发上颌骨发育不足[J]. 口腔颌面外科杂志, 2017, 27(3): 179-184.
	LIU Q C, WANG M J, SI J W, et al. Clinical evaluation on the anterior maxillary segmental distraction with rigid external distraction in the treatment of severe maxillary hypoplasia secondary to CLP[J]. Journal of Oral and Maxillofacial Surgery, 2017, 27(3): 179-184.
12	AKSU M, TANER T, SAHIN-VESKE P, et al. Pharyngeal airway changes associated with maxillary distraction osteogenesis in adult cleft lip and palate patients[J]. J Oral Maxillofac Surg, 2012, 70(2): e133-e140.
13	RICHARDSON S, SEELAN N S, SELVARAJ D, et al. Perceptual speech assessment after anterior maxillary distraction in patients with cleft maxillary hypoplasia[J]. J Oral Maxillofac Surg, 2016, 74(6): 1239.e1-1239.e9.
14	牟思璇, 朱妍菲, 杜常欣, 等. 改良牙支持式上颌骨前部牵引成骨术与上颌骨Le Fort Ⅰ型前徙术对唇腭裂患者腭咽部结构的影响[J]. 中国口腔颌面外科杂志, 2020, 18(5): 427-433.
	MOU S X, ZHU Y F, DU C X, et al. Comparative study of modified tooth-borne anterior maxillary segmental distraction osteogenesis and Le Fort I osteotomy on velopharyngeal structure changes in cleft lip palate patients[J]. China Journal of Oral and Maxillofacial Surgery, 2020, 18(5): 427-433.
15	OKCU K M, SENCIMEN M, KARACAY S, et al. Anterior segmental distraction of the hypoplastic maxilla by a tooth borne device: a study on the movement of the segment[J]. Int J Oral Maxillofac Surg, 2009, 38(8): 817-822.
16	TANIKAWA C, HIRATA K, AIKAWA T, et al. Efficacy of maxillary anterior segmental distraction osteogenesis in patients with cleft lip and palate[J]. Cleft Palate Craniofac J, 2018, 55(10): 1375-1381.

[1]	陈旭卓, 毛懿, 袁丹, 张善勇, 杨驰. 国产定制型全颞下颌关节假体的研发与应用[J]. 上海交通大学学报（医学版）, 2023, 43(5): 524-531.
[2]	吴兵, 李小敏, 柳思宇, 赵露露, 武文, 郝永强, 艾松涛. 改良3D打印病理切片盒在骨肿瘤病理拼接中的应用初探[J]. 上海交通大学学报（医学版）, 2023, 43(2): 180-187.
[3]	郑吉驷1，焦子先1，白果1，张善勇1，陈敏洁1，姜闻博2，杨驰1. 定制型颞下颌关节-下颌骨联合假体的临床初步应用[J]. 上海交通大学学报(医学版), 2020, 40(10): 1376-1381.
[4]	李逢时，刘光，刘晓兵#，陆信武#. 3D打印辅助预开窗及分支支架腔内修复术治疗累及内脏分支主动脉疾病的早期结果[J]. 上海交通大学学报(医学版), 2020, 40(10): 1388-1392.
[5]	李小敏1，曲扬1，武文2，赵亮3，张少霆3，郝永强2，戴尅戎2，艾松涛1. 3D打印切片盒在骨盆肿瘤边界三维定位中的应用初探[J]. 上海交通大学学报(医学版), 2020, 40(10): 1408-1413.
[6]	张忆恒1，杜静2, 3，夏安越1，崔金辉2，甘明哲2，刘培峰1. 基于3D打印技术的微芯片用于模拟肠绒毛和肿瘤表面形貌[J]. 上海交通大学学报（医学版）, 2019, 39(10): 1127-.
[7]	曲扬 1, 2，艾松涛 2，武文 1，王磊 1，李小敏 2，姜闻博 3，郝永强 1，戴尅戎 1. 3D打印个体化导板在骨肿瘤经皮穿刺活检中的初步应用[J]. 上海交通大学学报（医学版）, 2018, 38(9): 1053-.
[8]	童倩，陈振琦. 唇腭裂患者上气道形态影像学测量研究进展[J]. 上海交通大学学报（医学版）, 2017, 37(5): 712-.
[9]	郑吉驷，张善勇，杨驰，于洋，姜闻博，李慧武，王翔宇，焦子先，钟晓琪. 国产3D打印个性化全颞下颌关节的临床初步应用[J]. 上海交通大学学报（医学版）, 2016, 36(9): 1287-.
[10]	陈振琦, 钱玉芬, 沈刚, 等. 未经手术修复的恒牙列期腭裂患者牙颌模型分析[J]. , 2010, 30(5): 578-.

3D打印导板在上颌骨前段牵引成骨中的应用及精度测量

Application and accuracy assessment of a novel 3D-printed osteotomy guide in anterior maxillary segmental distraction osteogenesis

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 7

参考文献 16

相关文章 10

编辑推荐

Metrics