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目的:利用Surgicase5.0软件对发育期羊全颞下颌关节(temporomandibular joint,TMJ)置换进行手术设计,研究其重建后的下颌骨对称性。方法:选择6个月龄山羊6只,术前行CT检查,收集数据(Dicom格式),通过Surgicase5.0软件重建三维数字模型,结合快速成型技术获得羊三维头颅树脂模型,在模型上设计、制备个性化人工全TMJ假体,并模拟手术,进行全TMJ置换;右侧进行手术,作为实验组,左侧为对照组。术后1、4、12周行CT扫描,在三维模型上测量两侧下颌支高度(ramus heights,RH)、下颌体长度(mandibular body length,ML)、髁突顶点到下颌中切牙近中接触点距离(condyle-incisor,CI)、下牙槽座角到髁突顶点距离(subramental-condyle,BC),采用SPSS16.0软件包对所测数据进行左右侧配对t检验,左右侧各时间点分别与术前进行配对t检验。结果:所有动物均存活至实验完成,能正常进食。术后1、4周左右侧RH、ML、CI、BC均无显著差异(P>0.05);术后12周,除ML外,左右侧RH、CI、BC差异有显著性(P<0.05)。右侧术后1周RH、ML、CI、BC,4周RH、BC,12周RH与术前比较均无显著差异(P>0.05)。左侧术后1周RH、ML、CI、BC,4周RH与术前比较无显著差异(P>0.05)。结论:个性化设计的羊全TMJ假体能较好地行使关节功能。对发育期羊进行全TMJ假体置换,术后远期可能致面形不对称。
OBJECTIVE: To design the surgical design of temporomandibular joint (TMJ) replacement in developing sheep with Surgicase 5.0 software and study its mandibular symmetry after reconstruction. Methods: Six 6-month-old goats were selected. Preoperative CT examination was performed to collect data (Dicom format). Surgicase5.0 software was used to reconstruct the three-dimensional digital model and rapid prototyping technology to obtain three-dimensional sheep skull resin model. Preparation of personalized artificial total TMJ prosthesis, and simulated surgery, full TMJ replacement; right surgery, as the experimental group, the left for the control group. The CT scan was performed on the 1st, 4th, 12th week after operation, and the ramus heights (RH), mandibular body length (ML), condylar apex and mandibular central incisor were measured on the three- (CI) and subramental-condyle (BC). SPSS 16.0 software package was used to test the measured data by left and right side paired t-test, left and right time Point and preoperative paired t test. Results: All animals survived the experiment and were able to eat normally. There were no significant differences in RH, CI, BC at 1 week and 4 weeks after operation (P> 0.05). After 12 weeks, there were significant differences in RH, CI and BC except ML . There were no significant differences in RH, ML, CI, BC, 4 weeks RH, BC, 12 weeks RH on the right side compared with those before operation (P> 0.05). There was no significant difference in RH, ML, CI, BC, 4 weeks RH after 1 week of operation on the left side (P> 0.05). Conclusion: The sheep TMJ prosthesis designed individually can exercise well the joint function. Full TMJ prosthesis replacement of sheep in developmental stages may result in asymmetry in the long term.