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目的探讨已形成下颌偏斜、咬合错乱的单侧下颌骨缺损二期修复的有效方法。方法对单侧下颌骨部分切除造成下颌偏斜和咬合错乱的9例患者行术前CT扫描,计算机辅助设计与制作(CAD/CAM)快速原型技术重建颅颌面骨三维数字模型,并以健侧下颌骨为模板,镜像形成缺损侧下颌骨。激光树脂成型机打印下颌骨实体模型,在实体模型上按缺损范围设计钛网,使预成钛网与缺损下颌骨外形一致。数控成型机制备钛网,切取髂骨及其松质骨,联合预成钛网植入完成下颌骨缺损二期修复。结果预成钛网联合9例髂骨松质骨移植均获成功,创口愈合良好,下颌骨外形恢复满意,颜面偏斜得到有效矫正,咬合关系恢复正常。结论术前应用CAD/CAM快速原型技术制备预成钛网、联合自体松质骨游离移植二期修复单侧下颌骨缺损,不仅可以缩短手术时间,还能最大限度地重建下颌骨解剖外形、恢复患者颜面外观和咬合功能。
Objective To investigate the effective methods for the second-stage repair of unilateral mandibular defects that have formed the mandibular deviation and occlusion. Methods Nine patients with mandibular deviation and malocclusion caused by partial removal of unilateral mandible underwent preoperative CT scan and CAD / CAM rapid prototyping technique to reconstruct craniofacial bone three-dimensional digital model. Side of the mandible as a template, mirror the formation of the defect side of the mandible. The laser resin molding machine prints the mandible solid model, and designs the titanium mesh according to the defect range on the solid model, so that the preformed titanium mesh is consistent with the defect mandibular shape. The titanium mesh was prepared by CNC machine, the iliac bone and cancellous bone were cut off and the pre-formed titanium mesh was implanted to complete the second phase of mandibular defect repair. Results The preformed titanium mesh combined with 9 cases of iliac cancellous bone graft all achieved successful wound healing. The shape of mandible recovered satisfactorily. The facial deviation was effectively corrected and the occlusal relationship returned to normal. CONCLUSION: Pre-formed titanium mesh is prepared preoperatively using CAD / CAM rapid prototyping and unilateral autograft of cancellous bone is used to repair unilateral mandibular defects. This can not only shorten the operation time but also maximize the reconstruction of the mandible anatomy and recovery Patient appearance and bite function.