计算机辅助+3D打印技术在婴儿严重Pierre-Robin综合征下颌骨牵引成骨术中的应用

刘燕; 邱林; 傅跃先; 袁心刚; 肖军; 李天武; 毛小波; 丁雄辉; 梅爱莲

doi:10.16016/j.1000-5404.201808130

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计算机辅助+3D打印技术在婴儿严重Pierre-Robin综合征下颌骨牵引成骨术中的应用

临床医学 | 更新时间：2026-01-09

- 计算机辅助+3D打印技术在婴儿严重Pierre-Robin综合征下颌骨牵引成骨术中的应用
- Application of computer aided simulation and three-dimensional printing in mandibular distraction osteogenesis for serious Pierre-Robin syndrome in infants
- 第三军医大学学报 2019年41卷第6期页码：613-617
- 作者机构：
  
  400014 重庆，重庆医科大学附属儿童医院烧伤整形科，儿童发育疾病研究教育部重点实验室，儿童发育重大疾病国家国际科技合作基地，儿科学重庆市重点实验室
- 作者简介：
  
  [ 邱林, E-mail:dcliuyan@163.comQIU Lin, E-mail: dcliuyan@163.com
- 基金信息：
- DOI：10.16016/j.1000-5404.201808130
  中图分类号： R319;R726.873;R782.23
- 收稿：2018-08-19，
  
  修回：2018-10-22，
  
  纸质出版：2019-03-30
- 稿件说明：
移动端阅览
刘燕, 邱林, 傅跃先, 等. 计算机辅助+3D打印技术在婴儿严重Pierre-Robin综合征下颌骨牵引成骨术中的应用[J]. 第三军医大学学报, 2019,41(6):613-617.

Yan LIU, Lin QIU, Yuexian FU, et al. Application of computer aided simulation and three-dimensional printing in mandibular distraction osteogenesis for serious Pierre-Robin syndrome in infants[J]. Journal of Third Military Medical University, 2019, 41(6): 613-617.
刘燕, 邱林, 傅跃先, 等. 计算机辅助+3D打印技术在婴儿严重Pierre-Robin综合征下颌骨牵引成骨术中的应用[J]. 第三军医大学学报, 2019,41(6):613-617. DOI： 10.16016/j.1000-5404.201808130.

Yan LIU, Lin QIU, Yuexian FU, et al. Application of computer aided simulation and three-dimensional printing in mandibular distraction osteogenesis for serious Pierre-Robin syndrome in infants[J]. Journal of Third Military Medical University, 2019, 41(6): 613-617. DOI： 10.16016/j.1000-5404.201808130.

摘要

目的

探索婴儿严重Pierre-Robin综合征(Pierre-Robin syndrome

PRS)下颌骨牵引成骨术(mandibular distraction osteogenesis

MDO)的精准操作方法。

方法

选取本院2016-2017年收治的严重PRS婴儿10例，男女各5例，术前计算机软件模拟截骨及延长，并3D打印头模验证计算机模拟结果，3D打印个体化截骨模块，预弯延长器，术中指导截骨及安放延长器。术后5 d，以每日1.2 mm的速度进行骨延长治疗，延长至轻度反颌。记录手术时间及出血量、延长长度、术后拔气管插管时间、进食改善情况，延长结束后复查CT，明确舌根至咽后壁距离，并做多导睡眠图(polysomnogram

PSG)测量呼吸暂停低通气指数(apnea hyponea index

AHI)。3个月后，再次手术取出延长器。

结果

10例患儿均顺利完成治疗。第1次手术时间为(1.72±0.15)h；出血量(16±3)mL；20侧下颌骨延长长度为(11.11±1.18)mm；术后拔出气管插管时间为(6.10±0.74)d；拔管后开始经口喂养，7 d后8例患儿每日进奶量为(374.0±65.2)mL，2例仍需鼻饲喂养；延长结束后舌根至咽后壁距离为(7.17±0.70)mm；PSG示AHI(1.5±0.6)次。所有患儿牵引区成骨良好；无口角偏斜等面神经损伤症状。面下部后缩显著改善。

结论

术前计算机辅助+3D打印技术指导截骨、牵引，能提高严重PRS婴儿MDO中操作的精准性，缩短手术时间，减少出血，并能避免损伤重要解剖结构，是严重PRS婴儿MDO的精准操作方法。

Abstract

Objective

To establish a high-precision surgical approach for mandibular distraction osteogenesis (MDO) for treatment of serious Pierre-Robin syndrome (PRS) in infants.

Methods

Ten infants with serious PRS were enrolled in this study. Before the operation

osteotomy and distraction were simulated using computer software

followed by three-dimensional (3D) printing of the head model for verifying the simulation results. After the verification

the individualized osteotomy template and bended distractor were constructed using a 3D printer to assist in subsequent osteotomy and fixation of the distractor. Five days after the operation

the distraction started at a daily rate of 1.2 mm until mild anterior crossbite occurred. The operative time

blood loss

distracted length

postoperative tracheal intubation time

and improvement of eating behavior after the operation were recorded. After the distraction

all the infants underwent CT examination for measurement of the distance from the tongue root to the posterior pharyngeal wall; they also received polysomnogram (PSG) examination to determine the apnea hyponea index (AHI). The distractors were removed surgically at 3 months after the operation.

Results

The operations were completed successfully in all the 10 infants. The mean operative time of the first operation was 1.72±0.15 h with a mean blood loss of 16±3 mL; the mandibular distraction distance on 20 sides averaged 11.11±1.18 mm. The postoperative endotracheal intubation time was 6.10±0.74 d. After the extubation

8 infants started oral feeding

and their daily milk intake reached 374.0±65.2 mL 7 d later while the other 2 infants still required nasal feeding. After the distraction

the mean distance from the tongue root to the posterior pharyngeal wall was 7.17±0.70 mm. PSG showed AHI of 1.5±0.6 in these infants. All the infants had good osteogenesis in the distraction area without symptoms of facial nerve injury and showed significant improvement in the lower part of the face.

Conclusion

For infants with serious PRS

computer aided simulation combined with 3D printing for guiding osteotomy and distraction not only improves the surgical precision of MDO and shortens the operative time

but also avoids damages to important anatomical structures during the surgery.

关键词

Keywords

references

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