CAD/CAM技术辅助下使用Medpor?精确修复下颌轮廓凹陷

›› 2016, Vol. 36 ›› Issue (5): 416-420.

CAD/CAM技术辅助下使用Medpor?精确修复下颌轮廓凹陷

张轶群,章臻,胡静,李翔,李蔚,李继华

成都市人民南路三段14号四川大学华西口腔医院

收稿日期:2015-12-16 修回日期:2016-01-09 出版日期:2016-05-28 发布日期:2016-06-01
通讯作者: 李继华 E-mail:554230127@qq.com
基金资助:
国家自然科学基金

Using Computer-Aided Design and Manufacture (CAD/CAM) Techniques to Accurately Reconstruct Defects of Mandibular Contour with High-Density Porous Polyethylene（Medpor?）

Received:2015-12-16 Revised:2016-01-09 Online:2016-05-28 Published:2016-06-01

摘要/Abstract

摘要： 报导一种通过个体化Medpor来重塑下颌骨轮廓的方法，评价其治疗效果并讨论适应证。方法　选取四川大学华西口腔医院下颌骨轮廓凹陷病例17例，采集其CT数据，运用CAD/CAM、镜像反求、快速成型及3D打印技术设计并精确制作出手术模板，雕刻塑形出个性化Medpor，并指导准确植入体内，修复下颌凹陷畸形。结果　除1例植入体因迟发性感染取出外，其余患者恢复良好，复查定位照相对比示：患者下颌轮廓凹陷均得到较好修复，对称性得到明显改善，医患均对手术效果感到满意。结论　在CAD/CAM技术辅助下，运用Medpor可以精确修复下颌骨轮廓凹陷，是一种值得推广的方法。

关键词: 计算机辅助设计与制作, 快速成型技术, 高密度聚乙烯, 下颌骨轮廓凹陷

Abstract: Objective　 This paper reported a semi-digital technique to get an optimal fitting custom-made high-density porous Polyethylene (Medpor) for reconstruction of mandibular contour defects with the help of CAD/CAM and reverse engineering technology.Methods　17 patients suffered from defects of mandibular contour registered for the novel techniques adoption to reconstruct the mandibular contour. For each patient, computed tomography (CT) data were collected, CAD/CAM, reverse engineering and rapid prototyping (RP) by three-dimensional (3D) printing were used to fabricate the preoperative individualized geometric model. The mandibular contour defected areas were reconstructed by modelling and implanting Medpor.ResultsAll cases, except one with delayed infection whose implantation material was removed later on, recovered quite well. The follow-up observation showed that the previous defect zones had been accurately reconstructed, and a symmetric bony contour as well as an appealing facial appearance was acquired.Conclusions　Individualized Medpor implant based on CAD/CAM can accurately reconstruct defect of mandibular contour.

Key words: computer-aided design and manufacture（CAD/CAM）, rapid prototyping (RP), high-density porous Polyethylene (Medpor ), Defects of mandible

中图分类号:

　R782.2

张轶群章臻胡静李翔李蔚李继华. CAD/CAM技术辅助下使用Medpor?精确修复下颌轮廓凹陷[J]. , 2016, 36(5): 416-420.

参考文献

[1]Wang M,Liu W,Niu F,et al.Applying computer techniques in repairing mild mandibular asymmetry with high-density porous polyethylene[J].J Craniofac Surg,2012,23:44-46
[2]金骥,刘元波,宋彬,等.Medpor在第一,二鳃弓综合征矫治中的应用[J].中国美容医学,2011,20(11):1717-1719
[3]Morris CL,Barber RF,Day R.Orofacial prosthesis design and fabrication using stereolithography[J].Aust Dent J,2000,45(4):250-253
[4]Winder J,Cooke RS,Gray J,et al.Medical rapid prototyping and 3D CT in the manufacture of custom made cranial titanium plates[J].J Med Eng Technol,1999,23(1):26-28
[5]Samman N,Luck WK,Cheung LK,et al.Custom‐made titanium mandibular reconstruction tray[J].Aust Dent J,1999,44(3):195-199
[6]Andrade NN,Raikwar K.Medpor in maxillofacial deformities: report of three cases[J].J Oral Maxilllofac Surg,2009,8(2):192-195
[7]Rai A,Datarkar A,Arora A,et al.Utility of high density porous polyethylene implants in maxillofacial surgery[J].J Oral Maxilllofac Surg,2014,13(1):42-46
[8]CarboniA,Cerulli G,Perugini M,et al.Long-term follow-up of 105 porous polyethylene implants used to correct facial deformity[J].Eur J Plast Surg,2002,25(6):310-314
[9]Ridwan-Pramana A,Wolff J,Raziei A,et al.Porous polyethylene implants in facial reconstruction: outcome and complications[J].J Cranio Maxill Surg,2015,43(8):1330-1334
[10]Lai JB,Sittitavornwong S,Waite PD.Computer-assisted designedand computer-assisted manufactured polyetheretherketoneprosthesis for complex fronto-orbito-temporal defect[J].J Oral Maxillofac Surg,2011,69(4):1175-1180
[11]Wang G,Li J,Khadka A,et al.CAD/CAM and rapid prototyped titanium for reconstruction of ramus defect and condylar fracture caused by mandibular reduction[J].Oral Surg Oral Med Oral Pathol Oral Radiol Endod,2012,113:356-361
[12]HeisslerE,Fischer FS,Boiouri S,et al.Custom-made cast titanium implants produced with CAD/CAM for the reconstruction of cranium defects[J].Int J Oral MaxillofacSurg,1998,27:334-3383
[13]Gürlek A,Frat C,Aydogan H,et al.Augmentation mentoplasty with diced high-density porous polyethylene[J].Plast Reconstr Surg,2007,119:684-691
[14]Lin J,Chen X. Modified technique of chin augmentation with medpor for Asian patients [J].Aesthet Surg J,2012,32:799-780.
[15]Niechajev I.Facial reconstruction using porous high-density polyethylene (medpor): long-term results[J].Aesthet Plast Surg,2012,36:917-927
[16]Frodel J L,Lee S.The use of high-density polyethylene implants in facial deformities[J].Arch Otolaryngol ,1998,124:1219-1223
[17]Oliveira RV,de SouzaNunes LS,Nary Filho H,et al.Fibrovascularization and osteogenesis in high-density porous polyethylene implants[J].J Craniofac Surg,2009,20:1120-1124
[18]丛永健,宋敏.多孔材料应用在组织工程中的现状及前景[J].中国组织工程研究,2014,18(30):4889-4894
[19]Sevin K,Askar I,Saray A,et al.Exposure of high-density porous polyethylene (Medpor?) used for contour restoration and treatment[J].Brit J Oral Max Surg,2000,38(1):44-49
[20]Kim B S,Kang H J,Lee J.Improvement of the compressive strength of a cuttlefish bone‐derived porous hydroxyapatite scaffold via polycaprolactone coating[J].Journal of Biomedical Materials Research Part B: Applied Biomaterials,2013,101(7):1302-1309
[21]Seyhan T,Kircelli BH,Caglar B.Correction of septal and midface hypoplasia in maxillonasal dysplasia (Binder’s Syndrome) using high-density porous polyethylene[J].Aesth Plast Surg,2009,33:661-665
[22]高占巍,路会,陈波,等.Medpor假体修复下颌角截骨术后下颌角部分缺失畸形[J]. 中国美容医学,2013 (6): 619-622