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目的:根据下颌骨缺损类型,设计个体化内置式圆弧牵引器,通过三焦点牵引成骨技术修复下颌骨缺损畸形。方法:对患成釉细胞瘤行下颌骨部分切除的患者,确定手术切除范围及修复后下颌骨形态,在快速原型模型上设计个体化内置式圆弧形牵引器,应用三焦点转移盘牵引方式,在肿瘤切除同期行牵引成骨手术,牵引前间歇期7d,牵引参数为0.4 mm/次,2次/d,固定期6个月。拆除牵引器后,二期行牙列修复。结果:牵引器植入后牵引过程顺利,固定6个月后X线片显示新骨形成均良好,但2个转移盘间见纤维愈合,拆除牵引器时需行钛板内固定。牙列修复前,发现下颌骨形态略小、矢状向后缩,再次行双侧下颌支矢状劈开前移下颌骨,到达设计位置并稳定后,行覆盖义齿修复。结论:个体化内置式圆弧牵引器可以有效修复下颌骨大型缺损,避免传统骨移植手术造成的供区创伤,但在前期设计时,需要适当矫枉过正。
OBJECTIVE: To design a miniature internal retractor based on the type of mandibular defects and to repair mandibular defects by triple-focus distraction osteogenesis. Methods: The patients with ameloblastoma underwent partial excision of the mandible to determine the scope of resection and mandibular morphology after repair. In the rapid prototyping model, a personalized built-in arc tractor was designed. With the use of triple focus transfer disc traction During the same period of tumor resection and traction osteosynthesis, the interval before traction was 7 days. The traction parameters were 0.4 mm / time, 2 times / d, and the fixation period was 6 months. After removal of the tractor, the second line of dentition repair. RESULTS: Traction was successful after the traction device was implanted. X-ray films showed good bone formation after 6 months of fixation. However, the fibers were healed between the two transfer disks. Titanium plate fixation was required when removing the retractor. Before dentition restoration, it was found that the shape of the mandible was slightly smaller and the sagittal direction was retarded. The mandibular branch was again sagittally split and moved forward to the design position and stabilized, and then the overdenture was repaired. CONCLUSIONS: Individual built-in arc retractors can effectively repair large mandibular defects and avoid donor site trauma caused by traditional bone graft surgery. However, in the early design, proper overcorrection is needed.