3D-Printed "Jigsaw Puzzle" in Craniomaxillofacial Comminuted Fracture Reduction.

IF 1.4 4区 医学 Q3 SURGERY Annals of Plastic Surgery Pub Date : 2024-12-30 DOI:10.1097/SAP.0000000000004194
Tien-Hsiang Wang, Wen-Chan Yu, Yu-Chung Shih, Ching-En Chen, Shyh-Jen Wang, Hsu Ma, Wei-Ming Chen
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Abstract

Background: Surgical treatment of comminuted and multiple facial fractures is challenging, as identifying the bone anatomy and restoring the alignment are complicated. To overcome the difficulties, 3D-printed "jigsaw puzzle" has been innovated to improve the surgical outcome. This study aimed to demonstrate the feasibility of 3D-printed model in facial fracture restoration procedures.

Materials and methods: Patients with traumatic craniomaxillofacial fractures treated at a single institution were enrolled in this study. The exclusion criteria included the presence of mandibular fractures, greenstick fractures, isolated fractures, and revision cases. Fine-cut (1-mm thick) computed tomography images of each patient were assembled into a 3D model for preoperative planning. Major fragments were segmented in virtual surgical planning, printed out with a 3D printer as "jigsaw puzzle" pieces, and assembled with plates and screws as in surgical rehearsals. We further matched our study group with a control group of patients who underwent the corresponding procedures to compare operative time.

Results: Nine patients with craniomaxillofacial fractures were included in the study, including 2 patients with zygomaticomaxillary complex fractures and 7 patients with multiple fractures. No remarkable postoperative complications, such as enophthalmus or optic nerve injury, that require additional or revision surgery were noted. The mean operative time was 391 and 435 minutes in the study and control groups, respectively. The t test results were not statistically significant.

Conclusions: Surgeons can perform comprehensive preoperative planning, simulation, and obtain a real-time reference for facial bone reduction by using the 3D-printed "jigsaw puzzle" in multiple complicated craniomaxillofacial fractures.

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3d打印“拼图”在颅颌面粉碎性骨折复位。
背景:粉碎性和多发性面部骨折的外科治疗具有挑战性,因为确定骨骼解剖结构和恢复对齐是复杂的。为了克服这些困难,3d打印的“拼图”已经被创新,以改善手术效果。本研究旨在证明3d打印模型在面部骨折修复过程中的可行性。材料和方法:本研究纳入在单一机构治疗的创伤性颅颌面骨折患者。排除标准包括下颌骨折、绿枝骨折、孤立骨折和翻修病例。每个患者的精细切割(1毫米厚)计算机断层扫描图像被组装成一个3D模型,用于术前计划。主要碎片在虚拟手术计划中被分割,用3D打印机打印出“拼图”碎片,并像手术排练一样用钢板和螺钉组装。我们进一步将研究组与接受相应手术的对照组患者进行匹配,以比较手术时间。结果:本研究共纳入9例颅颌面骨折患者,其中2例为颧颌复合骨折,7例为多发骨折。无明显的术后并发症,如眼内陷或视神经损伤,需要额外或翻修手术。研究组和对照组的平均手术时间分别为391分钟和435分钟。t检验结果无统计学意义。结论:在多发复杂颅颌面骨折中,应用3d打印的“拼图”可以对外科医生进行全面的术前规划、模拟,获得面部骨复位的实时参考。
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来源期刊
CiteScore
2.70
自引率
13.30%
发文量
584
审稿时长
6 months
期刊介绍: The only independent journal devoted to general plastic and reconstructive surgery, Annals of Plastic Surgery serves as a forum for current scientific and clinical advances in the field and a sounding board for ideas and perspectives on its future. The journal publishes peer-reviewed original articles, brief communications, case reports, and notes in all areas of interest to the practicing plastic surgeon. There are also historical and current reviews, descriptions of surgical technique, and lively editorials and letters to the editor.
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