基于CBCT的计算机辅助设计在髁突矢状骨折切开复位内固定中的应用

doi:10.19438/j.cjoms.2026.01.010

摘要/Abstract

摘要： 目的: 探讨锥形束CT（CBCT）在髁突矢状骨折诊疗中的应用,评价计算机辅助设计在髁突矢状骨折切开复位内固定手术中的有效性。方法: 选取2022年3月—2023年10月在河北医科大学第三医院就诊的21例髁突矢状骨折患者作为研究对象。所有患者术前均接受CBCT检查,并使用Mimics软件进行三维重建和计算机辅助设计。通过分析术前影像资料,明确骨折类型、移位情况及固定方案。术后通过影像学和临床检查评估复位效果和预后情况。结果: 所有患者的术中诊断与术前CBCT影像诊断结果一致。术后影像学检查显示,实际内固定物长度、植入位置及角度与术前设计基本一致,其中19例患者达到或接近解剖学复位。术后3个月,患者最大开口度较术前显著改善,影像学评估显示12例患者达到1级愈合,7例达到2级愈合。结论: CBCT检查为髁突矢状骨折的临床诊疗提供了有效参考。术前结合CBCT成像和计算机辅助设计能够直观显示骨折情况,指导手术方案制定,提高手术精确度和解剖复位率。

关键词: 髁突矢状骨折, 切开复位内固定, CBCT, 计算机辅助设计

Abstract: PURPOSE: To explore the value of CBCT in the diagnosis and treatment of sagittal condylar fractures, and to evaluate the application of computer-aided design in open reduction and internal fixation of condylar sagittal fractures. METHODS: A total of 21 patients with condylar sagittal fracture who were treated in the Third Hospital of Hebei Medical University from March 2022 to October 2023 were selected as the study objects. All patients were examined by CBCT before surgery and underwent 3D reconstruction and computer-aided design using Mimics software. Through the analysis of preoperative imaging data, the fracture type, displacement and fixation plan were determined. The reduction outcomes and prognosis were evaluated by imaging and clinical examinations. RESULTS: Intraoperative diagnosis of all patients was consistent with preoperative CBCT imaging diagnosis. Postoperative imaging results showed that the actual length, implant position and angle of the internal fixation were basically consistent with the preoperative design, and 19 patients achieved or approached anatomical reduction. At 3 months after surgery, the maximum opening of the patients was significantly improved compared with that before surgery, and imaging evaluation showed that 12 patients achieved grade 1 healing and 7 patients achieved grade 2 healing. CONCLUSIONS: CBCT provides an effective reference for clinical diagnosis and treatment of sagittal fracture of condyle. The combination of preoperative CBCT and computer-aided design is helpful to guide the surgical treatment of sagittal fracture of condyle and has high clinical value.

Key words: Sagittal fracture of the mandibular condyle, Open reduction and internal fixation, CBCT, Computer-assisted design

中图分类号:

R782.4
R683

程立军, 赵丽丽, 魏泽全, 蒋煜鑫, 赵民朝. 基于CBCT的计算机辅助设计在髁突矢状骨折切开复位内固定中的应用[J]. 中国口腔颌面外科杂志, 2026, 24(1): 59-64.

Cheng Lijun, Zhao Lili, Wei Zequan, Jiang Yuxin, Zhao Minchao. Application of computer-aided design based on CBCT in open reduction and internal fixation of sagittal fractures of the mandibular condyle[J]. China J Oral Maxillofac Surg, 2026, 24(1): 59-64.

参考文献

[1] Shakya S, Li KD, Huang D, et al.Virtual surgical planning is a useful tool in the surgical management of mandibular condylar fractures[J]. Chin J Traumatol, 2022, 25(3): 151-155.
[2] Wang WH, Deng JY, Zhu J, et al.Computer-assisted virtual technology in intracapsular condylar fracture with two resorbable long-screws[J]. Br J Oral Maxillofac Surg, 2013, 51(2): 138-143.
[3] 张益, 李祖兵, 何黎升, 等.中华口腔医学会成人髁突骨折诊疗专家共识: T/CHSA011-2023[S]. 北京: 中华口腔医学会,2023.
Zhang Y, Li ZB, He LS, et al.Chinese Stomatological Association adult condylar fracture diagnosis and treatment expert consensus. T/CHSA011-2023[S]. Beijing: Chinese Academy of Stomatology, 2023.
[4] Ellis E 3rd, Throckmorton GS, Palmieri C. Open treatment of condylar process fractures: assessment of adequacy of repositioning and maintenance of stability[J]. J Oral Maxillofac Surg, 2000, 58(1): 27-34.
[5] 王保利, 何冬梅, 杨驰, 等. 影响髁突囊内骨折非手术治疗效果的因素分析[J]. 中国口腔颌面外科杂志, 2016, 14(3): 228-233.
Wang BL, He DM, Yang C, et al.Factors affecting the outcomes of non-surgical treatment of intracapsular condylar fractures[J]. China Journal of Oral and Maxillofacial Surgery, 2016, 14(3): 228-233.
[6] 黄国伟, 郑吉驷, 张善勇, 等. 曲面体层X线,CT和MRI在髁突骨折诊断中的应用比较[J]. 中华口腔医学杂志, 2014, 49(7): 434-439.
Huang GW, Zheng JS, Zhang SY, et al.The value of paronamic radiograph, CT and MRI for the diagnosis of condylar fracture[J]. Chinese Journal of Stomatology, 2014, 49(7): 434-439.
[7] 黄洪, 徐旭, 严钦, 等. MSCT三维重建与MRI对下颌骨髁突骨折的诊断效果比较[J]. 中华全科医学, 2022, 20(3): 461-463, 510.
Huang H, Xu X, Yan Q, et al.Comparison of MSCT three-dimensional reconstruction and MRI in the diagnosis of mandibular condylar fracture[J]. Chinese Journal of General Practice, 2022, 20(3): 461-463, 510.
[8] Collier J, Bridle C, Makdissi J, et al.The role of pre-operative 3-dimension CT evaluation of Type B intracapsular condylar fractures to determine the feasibility of lag screw osteosynthesis[J]. Br J Oral Maxillofac Surg, 2008, 46: e37-e38.
[9] Grassi R, Guerra E, Berritto D.Bone fractures difficult to recognize in emergency: may be cone beam computed tomography (CBCT) the solution?[J]. Radiol Med, 2023,128(1):1-5.
[10] Frackiewicz W, Jankowska A, Machoy ME.CBCT and modern intraoral scanners as tools for developing comprehensive, interdisciplinary treatment plans[J]. Adv Clin Exp Med, 2024, 33(11):1267-1276.
[11] 吴亮颖,刘坚. CBCT与3D打印技术在口腔颌面外科的研究进展[J]. 现代医药卫生, 2022, 38(21): 3694-3697.
Wu LY, Liu J.Research progress of CBCT and 3D printing technology in oral and maxillofacial surgery[J]. Modern Medicine and Hygiene, 2022, 38(21): 3694-3697.
[12] Kaasalainen T, Ekholm M, Siiskonen T, et al.Dental cone beam CT: an updated review[J]. Phys Med, 2021, 88:193-217.
[13] Nardi C, Talamonti C, Pallotta S, et al.Head and neck effective dose and quantitative assessment of image quality: a study to compare cone beam CT and multislice spiral CT[J]. Dentomaxillofac Radiol, 2017, 46(7): 20170030.
[14] Scarfe WC, Farman AG, Sukovic P.Clinical applications of cone-beam computed tomography in dental practice[J]. J Can Dent Assoc, 2006, 72(1): 75-80.
[15] Kamburoglu K, Kolsuz E, Kurt H, et al.Accuracy of CBCT measurements of a human skull[J]. J Digit Imaging, 2011, 24(5):787-793.
[16] Stratemann SA, Huang JC, Maki K, et al.Comparison of cone beam computed tomography imaging to physical measures[J]. Dentomaxillofac Radiol, 2008, 37(2): 80-93.
[17] He D, Yang C, Chen M, et al.Intracapsular condylar fracture of the mandible: our classification and open treatment experience[J]. J Oral Maxillofac Surg, 2009, 67(8): 1672-1679.
[18] Luo S, Li B, Long X, et al.Surgical treatment of sagittal fracture of mandibular condyle using long-screw osteosynthesis[J]. J Oral Maxillofac Surg, 2011, 69(7): 1988-1994.
[19] 周昌龙,王永盛,张建伟. 外侧入路16 mm长钛钉固定髁突矢状骨折的临床应用[J]. 现代口腔医学杂志, 2011, 25(3): 174-178.
Zhou CL, Wang YS, Zhang JW.Clinical application of 16 mm long titanium screws through lateral approach for internal fixation in treating sagittal condylar fracture[J]. Journal of Modern Stomatology, 2011, 25(3): 174-178.
[20] Yuan X, Xuan M, Tian W, et al.Application of digital surgical guides in mandibular resection and reconstruction with fibula flaps[J]. Int J Oral Maxillofac Surg, 2016, 45(11): 1406-1409.
[21] Moolenaar JZ, Tümer N, Checa S.Computer-assisted preoperative planning of bone fracture fixation surgery: a state-of-the-art review[J]. Front Bioeng Biotechnol, 2022,10:1037048.
[22] Li P, Tang W, Liao C, et al.Clinical evaluation of computer-assisted surgical technique in the treatment of comminuted mandibular fractures[J]. J Oral Maxillofac Surg Med Pathol, 2015, 27: 332-336.
[23] Pavlychuk T, Chernogorskyi D, Chepurnyi Y, et al.Application of CAD/CAM technology for surgical treatment of condylar head fractures: a preliminary study[J]. J Oral Biol Craniofac Res, 2020, 10(4): 608-614.
[24] Yang ML, Zhang B, Zhou Q, et al.Minimally-invasive open reduction of intracapsular condylar fractures with preoperative simulation using computer-aided design[J]. Br J Oral Maxillofac Surg, 2013, 51(3): e29-e33.
[25] Iwai T, Yajima Y, Matsui Y, et al.Computer-assisted preoperative simulation for screw fixation of fractures of the condylar head[J]. Br J Oral Maxillofac Surg, 2013, 51(2): 176-177.
[26] 孟凡文. 复位螺钉、侧向螺钉技术手术治疗下颌髁突矢状骨折的研究[D].西安: 第四军医大学, 2009.
Meng FW.Study on surgical treatment of sagittal fracture of mandibular condyle with reduction screw and lateral screw technique [D]. Xi’an: Fourth Military Medical University, 2009.