数字化导板在颞下颌关节强直保留髁突手术中的指导作用

中国口腔颌面外科杂志 ›› 2015, Vol. 13 ›› Issue (1): 31-37.

数字化导板在颞下颌关节强直保留髁突手术中的指导作用

陆川¹, 何冬梅^1**, 杨驰^1**, 黄栋¹, 白果¹, 袁建兵²

1.上海交通大学医学院附属第九人民医院·口腔医学院口腔外科,上海市口腔医学重点实验室,上海 200011; 2.上海交通大学机械动力工程学院,上海 200240

收稿日期:2014-05-13 出版日期:2015-02-10 发布日期:2015-03-12
通讯作者: 何冬梅,E-mail:lucyhe119@163.com;杨驰,E-mail:yangchi63@hotmail.com。*共同通信作者 E-mail:1041123231@qq.com
作者简介:陆川（1989-）,男,硕士研究生

Digital guide assisted in retaining the residual condyle of temporomandibular joint ankylosis surgery

LU Chuan¹, HE Dong-mei¹, YANG Chi¹, HUANG Dong¹, BAI Guo¹, YUAN Jian-bing²

1.Department of Oral Surgery, Ninth People′s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology. Shanghai 200011; 2.School of Mechanical and Power Engineering, Shanghai Jiao Tong University. Shanghai 200240, China

Received:2014-05-13 Online:2015-02-10 Published:2015-03-12
About author:Supported by Research Fund of Science and Technology Committee of Shanghai Municipality (08DZ2271100);Program for Innovative Research Team of Shanghai Municipal Education Commission;Research and Special Project Funding of Health and Welfare Industry (201002017);Scientific Research Foundation for Returned Overseas Chinese Scholars, Ministry of Education of China
Supported by:
上海市科学技术委员会资助项目（08DZ2271100）; 上海高校创新团队发展计划; 卫生行业公益基金（201002017）; 教育部留学回国人员科研启动基金

摘要/Abstract

摘要： 目的设计制作数字化导板（digital guide）,用于指导颞下颌关节强直（temporomandibular joint ankylosis,TMJA）外侧成形术（lateral gap arthroplasty,LAP）中髁突残余（residual condyle）的保留,并评价其应用效果。方法收集2012年1月—2014年1月间收治的TMJA患者,选择骨球内侧存在髁突残余者纳入研究。采用 ProPlan CMF 1.4软件进行术前设计,明确骨球范围及其与髁突残余的关系,设计数字化导板并采用快速成型技术制作完成,术中用以指导骨球的截除。评价导板的就位情况及对重要解剖结构的保护。术后拍摄CT评价截骨效果并与手术设计进行拟合,评价导板的准确性。结果 5例7侧关节手术中,导板就位稳定,指导截骨准确,未伤及颅底和外耳道前壁,有效保护了内侧的髁突残余。术后CT显示截骨与术前设计的平均误差为1.044 mm。结论数字化导板可以准确有效地指导强直骨球的切除,有效保护了髁突残余、颅底和外耳道。

关键词: 髁突残余, 数字化导板, 颞下颌关节强直, 颞下颌关节外侧成形术

Abstract: PURPOSE: We design and fabricate a digital guide to help retaining the residual condyle in the lateral gap arthroplasty (LAP) of temporomandibular joint ankylosis (TMJA) and evaluate the effect. METHODS: All TMJA patients treated in our department from January 2012 to January 2014 were included for the study with the inclusion criteria as follows there was a residual condyle on the coronal CT and digital guides were designed to help retaining the residual condyle in LAP; ProPlan CMF 1.4 software (Materialise Medical, Leuven, Belgium) was used to complete preoperative design. Range and relation between bone fusion and residual condyle was determined. The guides were designed and made by stereolithography, and then applied in surgeries. The effect of the digital guides including the intraoperative fitness and protection of important structures was evaluated. The fusion results of the postoperative CT and preoperative design were analyzed. RESULTS: Among the total 5 surgeries with 7 joints, the digital guides fit well and accurately guide the osteotomy. The residual condyle, skull base and external auditory canal were well protected. Postoperative CT showed the average difference between the surgical results and the preoperational designs was 1.044 mm. CONCLUSIONS: Digital guides can accurately guide the osteotomy of the lateral bone fusion and protect residual condyle, skull base and external auditory canal.

Key words: Residual condyle, Digital guide, Temporomandibular joint ankylosis, Lateral gap arthroplasty

中图分类号:

R782.6

陆川, 何冬梅, 杨驰, 黄栋, 白果, 袁建兵. 数字化导板在颞下颌关节强直保留髁突手术中的指导作用[J]. 中国口腔颌面外科杂志, 2015, 13(1): 31-37.

LU Chuan, HE Dong-mei, YANG Chi, HUANG Dong, BAI Guo, YUAN Jian-bing. Digital guide assisted in retaining the residual condyle of temporomandibular joint ankylosis surgery[J]. China J Oral Maxillofac Surg, 2015, 13(1): 31-37.

参考文献

[1] He D, Yang C, Chen M, et al. Traumatic temporomandibular joint ankylosis: our classification and treatment experience [J]. J Oral Maxillofac Surg, 2011, 69(6): 1600-1607.
[2] 温济全,翦新春,唐瞻贵,等.颞下颌关节内强直的病因学分析 [J]. 现代口腔医学杂志, 2002, 16(6): 565.
[3] 牙祖蒙, 谭颖徽, 王建华, 等. 钛制关节头置换髁状突治疗颞下颌关节骨性强直71例 [J]. 整形再造外科杂志, 2004, 1(2): 74-77.
[4] el-Sheikh MM. Temporomandibular joint ankylosis: the Egyptian experience [J]. Ann R Coll Surg Engl, 1999, 81(1): 12-18.
[5] Roychoudhury A, Parkash H, Trikha A. Functional restoration by gap arthroplasty in temporomandibular joint ankylosis: a report of 50 cases [J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1999, 87(2): 166-169.
[6] Valentini V, Vetrano S, Agrillo A, et al. Surgical treatment of TMJ ankylosis: our experience (60 cases) [J]. J Craniofac Surg, 2002, 13(1): 59-67.
[7] He D, Yang C, Chen M, et al. Surgical treatment of traumatic temporomandibular joint ankylosis with medially displaced residual condyle: surgical methods and long-term results [J]. J Oral Maxillofac Surg, 2011, 69(9): 2412-2418.
[8] Nitzan DW, Bar-Ziv J, Shteyer A. Surgical management of temporomandibular joint ankylosis type III by retaining the displaced condyle and disc[J]. J Oral Maxillofac Surg,1998,56(10): 1133-1139.
[9] Schmelzeisen R, Gellrich NC, Schramm A, et al. Navigation guided resection of temporomandibular joint ankylosis promotes safety in skull base surgery[J]. J Oral Maxillofac Surg,2002,60(11): 1275-1283.
[10] Yu HB, Shen GF, Zhang SL, et al. Navigation-guided gap arthroplasty in the treatment of temporomandibular joint ankylosis [J]. Int J Oral Maxillofac Surg, 2009, 38(10): 1030-1035.
[11] Chandran R, Keeler GD, Christensen AM, et al. Application of virtual surgical planning for total joint reconstruction with a stock alloplast system [J]. J Oral Maxillofac Surg, 2011, 69(1): 285-294.
[12] Coppen C, Weijs W, Bergé SJ, et al. Oromandibular reconstruction using 3D planned triple template method [J]. J Oral Maxillofac Surg, 2013, 71(8): e243-247.
[13] Nkenke E, Eitner S. Complex hemimaxillary rehabilitation with a prefabricated fibula flap and cast-based vacuum-formed surgical template [J]. J Prosthet Dent, 2013, 111(6): 521-524.
[14] Huang D, He DM, Yang C, et al. Computer-assisted local resection for exostosis osteochondroma of the mandibular condyle [J]. J Craniofac Surg, 2013, 24(4): e446-449.
[15] Eggers G, Mühling J. Template-based registration for image-guided skull base surgery [J]. Otolaryngol Head Neck Surg, 2007, 136(6): 907-913.