摘要/Abstract
摘要： 目的 ·介绍金属高分子一体式全颞下颌关节（ temporomandibular joint，TMJ）假体临床应用的标准化流程，并评估假体植入的精确性和临床效果。方法 ·纳入 8名患有终末期 TMJ疾病需要接受全关节置换的患者。术前获取患者的颅颌面 CT数据，导入 Mimics 18.0软件中设计个性化假体及数字化导板。分别利用 3D打印、搅拌摩擦焊接（ friction spot welding，FSW）和计算机辅助加工（computer-aided manufacture，CAM）制造并加工假体的不同组件。术后对假体植入的精确性和有效性进行详细评估。结果 ·在数字化导板和虚拟手术计划（ virtual surgical planning，VSP）的指导下，所有假体在手术过程中稳定就位并固定。术前术后的拟合结果显示，假体术后位置与术前设计吻合良好，全假体系统的平均偏差为 0.417 mm（范围： 0.279～ 0.561 mm）。所有患者术后均表现出良好的面部对称性，疼痛、功能和张口度等疗效指标均得到明显改善。结论 ·标准化流程的指导确保了国产个性化全 TMJ假体临床应用的精确性和有效性。
关键词: 颞下颌关节, 全颞下颌关节假体, 假体设计, 临床应用
Abstract:
Objective · To introduce a standardized workflow for clinical application of Chinese customized TC4/UHMWPE connected total temporomandibular joint (TMJ) prostheses, and to evaluate its accuracy and clinical effectiveness. Methods · Eight patients with the end stage TMJ diseases were included in this study. The computed tomography (CT) data for patients were obtained and transformed into the Mimics 18.0 software preoperatively for the designing of the prostheses and digital templates. Three-dimensional (3D) printing, friction spot welding (FSW) and computer-aided manufacture (CAM) were used to fabricate different components of the prostheses. The effectiveness of intraoperative application and the accuracy of merging results were evaluated postoperatively. Results · With the guidance of digital templates and virtual surgical planning (VSP), all the prostheses were placed smoothly and fixed stably during surgical procedures. The merging results showed that the prostheses position matched with the preoperative design well, with an mean deviation of 0.417 mm (range: 0.279 to 0.561 mm) for the whole prosthesis system. All the patients exhibited good facial symmetry and satisfactory improvement in pain, function and mouth opening postoperatively. Conclusion · The standardized workflow ensures the accuracy and efficiency in clinical application of Chinese customized total TMJ prostheses.
Key words: temporomandibular joint, total temporomandibular joint prostheses, prosthesis design, clinical application
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