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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Pro Plan 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。
OBJECTIVE: To design a digital guide for guiding the retention of residual condyle in temporomandibular joint ankylosis (TMJA) lateral margin arthroplasty (LAP) and evaluate its application effect. Methods: Patients with TMJA admitted between January 2012 and January 2014 were enrolled in the study. The Pro Plan CMF 1.4 software was used to preoperatively design the range of the bone sphere and its relationship with the remnant of the condyle. The digital guide plate was designed and fabricated by rapid prototyping technique. The procedure was used to guide the removal of the bone ball. Evaluate the placement of the guide and the protection of important anatomical structures. Postoperative CT evaluation of osteotomy and surgical design to fit, evaluate the accuracy of guide. Results: In 5 cases of 7-sided joint surgery, the guide plate was in stable position and the osteotomy guide was correct. The anterior skull base and external auditory canal were not injured, which effectively protected the medial condylar remnants. Postoperative CT showed that the average error between preoperative design and osteotomy was 1.044 mm. Conclusion: Digital guide plate can guide the removal of tetanic bone accurately and effectively, and effectively protect condylar remnant, skull base and external auditory canal.