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目的:研究快速原型技术对复杂下颌骨缺损重建术后患者髁突位置和颞下颌关节功能的影响。方法:对下颌骨良性肿瘤切除同时需保留髁突的复杂缺损重建术患者50例,其中20例用快速原型技术指导下颌骨重建(快速原型组),30例用传统方法进行下颌骨重建(对照组)。所有患者手术前、后均行下颌骨及颞下颌关节三维螺旋CT扫描,测量髁突的三维空间位置,并用Fricton颞下颌关节功能量表进行术后颞下颌关节功能检查,计算颞下颌关节功能障碍指数(DI)、肌压痛指数(PI)及颞下颌关节紊乱指数(CMI)。采用SPSS11.5软件包,用配对t检验分析组内手术前、后差异,Mann-Whitney非参数检验分析组间差异。结果:所有肿瘤术后无复发,移植骨成活,关系良好。快速原型组外形对称,下颌运动功能正常,髁突位置正常。对照组6例面型不对称,8例CT显示患侧髁突有较明显的移位。快速原型组手术前、后的髁突前距离,内距离,上、下距离及长轴夹角数值无统计学差异。对照组手术前、后前距离有统计学差异(P<0.05),上、下距离及长轴夹角有显著性统计学差异(P<0.01),内距离无统计学差异(P>0.05)。快速原型组及对照组组间术前髁突位置无统计学差异(P>0.05),而术后前距离及上、下距离有统计学差异(P<0.05),长轴夹角有显著性统计学差异(P<0.01),内距离无统计学差异(P>0.05)。快速原型组及对照组间术后颞下颌关节各项功能指数中,DI及CMI差异有统计学意义(P<0.05),PI差异无统计学意义(P>0.05)。结论:快速原型技术能通过保持髁突三维空间位置,改善术后颞下颌关节功能,提高下颌骨重建效果。
Objective: To study the effect of rapid prototyping on the position of condyles and the function of temporomandibular joint in patients with complex mandibular reconstruction. METHODS: Fifty patients undergoing congenital complex defect reconstruction with resection of benign tumors of the mandible, 20 of whom underwent rapid mandibular reconstruction with rapid prototyping (rapid prototyping) and 30 underwent mandibular reconstruction using conventional methods (control group). All patients underwent three-dimensional spiral CT scan of the mandible and temporomandibular joint before and after operation to measure the three-dimensional position of the condyle. The function of temporomandibular joint was examined with Fricton TMJF, and the effects of temporomandibular joint dysfunction Index (DI), muscle tenderness index (PI) and temporomandibular disorder index (CMI). Using SPSS11.5 software package, paired t test was used to analyze intraoperative preoperative and postoperative differences, and Mann-Whitney nonparametric test was used to analyze the differences between groups. Results: All the tumors had no recurrence after surgery and the bone graft survived. The relationship was good. Rapid prototyping group shape symmetry, mandibular motor function, normal condylar position. The control group, 6 cases of asymmetric surface type, 8 cases of CT showed a more significant displacement of the condyles. There was no significant difference in the values of the distance between the condyle before and after the operation, the inner distance, the distance between the upper and lower limbs, and the angle between the long axes before and after the operation. There was significant difference in the distance before and after the operation in the control group (P <0.05), and there was significant difference between the upper and lower distance and the angle of the long axis in the control group (P <0.01) . There was no significant difference in the position of preoperative condyle between the rapid prototyping group and the control group (P> 0.05), while there was a significant difference in the distance before and after the operation (P <0.05) Statistical differences (P <0.01), no significant difference within the distance (P> 0.05). There were significant differences in DI and CMI between the rapid prototypical group and the control group in each function index of temporomandibular joint (P <0.05), but there was no significant difference in PI between the two groups (P> 0.05). Conclusion: Rapid prototyping can improve the effect of mandibular reconstruction by maintaining the position of condyle in three dimensions, improving the function of temporomandibular joint.