技术领域technical field
本发明涉及颌面外科医疗器械领域，尤其涉及一种下颌骨双颏孔区骨折复位固定导板。The invention relates to the field of maxillofacial surgery medical instruments, in particular to a guide plate for reduction and fixation of mandibular double mental foramen fractures.
背景技术Background technique
下颌骨骨折主要由外伤引起，近年来随着车祸等发生频率的不断升高，下颌骨骨折的发病几率也在逐年升高。下颌骨骨折可为单发或多发，在火器伤时，常为粉碎性骨折，主要有骨折段移位和咬合错乱等临床表现。有较好的治疗方法，治愈率高。早期骨折重定和固定是关键。Mandibular fractures are mainly caused by trauma. In recent years, with the increasing frequency of traffic accidents, the incidence of mandibular fractures has also increased year by year. Mandibular fractures can be single or multiple. In the case of firearm injuries, they are often comminuted fractures, mainly with clinical manifestations such as fracture segment displacement and occlusal disorder. There are better treatment methods, and the cure rate is high. Early fracture repositioning and fixation is key.
下颌骨骨折，特别是复杂的下颌骨骨折，可导致患者面部的畸形及口颌系统功能的丧失，下颌骨骨折患者的治疗要点最重要的是要精确地恢复其下颌骨正常的解剖形态，从而重建其面部的美观及正常的口颌系统生理功能。其中，下颌骨双颏孔区粉碎性骨折由于骨块粉碎，需要涉及重建板及小型接骨板的联合使用，其临床治疗相当困难。如何精准的对粉碎的骨块进行解剖复位，准确的放置接骨板及重建板，重建正确咬合关系，避免损伤颏神经等重要解剖结构，是此类骨折手术中的重点及难点。Mandibular fractures, especially complex mandibular fractures, can lead to facial deformities and loss of the function of the oral and jaw system. The most important point of treatment for patients with mandibular fractures is to accurately restore the normal anatomical shape of the mandible, thereby Reconstruct the beauty of the face and the normal physiological function of the oral and maxillary system. Among them, comminuted fractures in the double mental foramen area of the mandible require the combined use of reconstruction plates and small bone plates due to the comminution of bone fragments, and its clinical treatment is quite difficult. How to accurately anatomically reduce the comminuted bone fragments, accurately place the bone plate and reconstruction plate, reconstruct the correct occlusal relationship, and avoid damage to important anatomical structures such as the mental nerve are the key points and difficulties in this type of fracture surgery.
目前，数字化外科技术迅速发展并广泛应用于下颌骨骨折的手术治疗中，精准修复与功能重建是该类手术精准治疗的目标，其中应用最多的数字医学手段包括外科导航、钛板预成形及3D导板技术。导航技术易出现一定的系统误差，存在配准注册失败的可能，操作相对较复杂，在下颌骨骨折治疗的应用较少。钛板预成形技术是在术前3D打印模型上，进行钛板的预成形，术中将预成形的钛板放置在术前模拟摆放的位置，可精准的辅助骨折的复位及固定，近年来在下颌骨骨折中已有广泛的应用。但由于在下颌骨双颏孔区粉碎性骨折的治疗中，需要对重建板及小型接骨板进行预成形（常规治疗方案是一块重建板和两块小型接骨板联合使用），而重建板由于体积大，机械强度高，预成形较为困难，在缺乏辅助定位装置的情况下，术中重建板实际摆放位置与术前在模型上模拟摆放位置往往存在较大偏差，不能达到精准治疗的需求。At present, digital surgical technology is developing rapidly and widely used in the surgical treatment of mandibular fractures. Precise repair and functional reconstruction are the goals of precision treatment in this type of surgery. Among them, the most widely used digital medical methods include surgical navigation, titanium plate preforming and 3D surgery. Guide plate technology. Navigation technology is prone to certain systematic errors, and there is a possibility of failure in registration and registration. The operation is relatively complicated, and its application in the treatment of mandibular fractures is seldom. Titanium plate preforming technology is to preform the titanium plate on the preoperative 3D printing model. During the operation, the preformed titanium plate is placed in the position simulated before the operation, which can accurately assist the reduction and fixation of the fracture. In recent years, It has been widely used in mandibular fractures. However, in the treatment of comminuted fractures in the bimental foramen area of the mandible, it is necessary to preform the reconstruction plate and the small bone plate (the conventional treatment plan is to use one reconstruction plate and two small bone plates in combination), and the reconstruction plate is due to its volume. large, high mechanical strength, and difficult to preform. In the absence of auxiliary positioning devices, there is often a large deviation between the actual placement of the intraoperative reconstruction plate and the simulated placement on the model before surgery, which cannot meet the needs of precise treatment. .
导板技术操作方便，误差较小，故在手术中应用较多，但导板在实际手术应用过程中，也存在一定的问题。现有的骨折复位导板，只能用于复核手术复位效果，不能辅助下颌骨骨折的固定，且现有的复位导板上缺乏引导钛板就位的结构，预成形的钛板难以精准就位。因此，如何合理的优化设计数字外科导板，使其精确复位骨折断端，有效引导预成形重建板准确就位，减少术前设计与预成形的误差，降低手术难度和缩短时间，从而达到对复杂下颌骨骨折的精确化，个性化和微创化治疗是临床亟需解决的问题。The guide plate technology is easy to operate and has small errors, so it is widely used in surgery, but there are also certain problems in the actual operation process of the guide plate. Existing fracture reduction guides can only be used to review the effect of surgical reduction, and cannot assist in the fixation of mandibular fractures. Moreover, the existing reduction guides lack a structure to guide the titanium plate in place, and it is difficult to accurately place the preformed titanium plate. Therefore, how to rationally optimize the design of the digital surgical guide plate so that it can accurately reset the fracture end, effectively guide the pre-shaped reconstruction plate in place, reduce the error of preoperative design and pre-shaping, reduce the difficulty of surgery and shorten the time, so as to achieve the goal of complex surgery. Precise, individualized and minimally invasive treatment of mandibular fractures is an urgent problem to be solved clinically.
发明内容Contents of the invention
为了解决以上技术问题，本发明提供一种下颌骨双颏孔区骨折复位固定导板，可精准治疗下颌骨双颏孔区粉碎性骨折的3D打印个性化复位固定导板，结构简单，成本低，操作简便，有利于颌面外科医生在术中复位并固定下颌骨双颏孔区粉碎性骨折，从而达到精确化手术的目标，降低手术难度，缩短手术时间。In order to solve the above technical problems, the present invention provides a mandibular double-mental foramen fracture reduction and fixation guide plate, which can accurately treat comminuted fractures in the mandibular double-mental foramen area. It is simple and convenient for maxillofacial surgeons to reset and fix comminuted fractures in the mandibular bimental foramen area during the operation, so as to achieve the goal of precise surgery, reduce the difficulty of surgery, and shorten the operation time.
解决以上技术问题的本发明中的一种下颌骨双颏孔区骨折复位固定导板，包括导板本体，其特征在于：设有接骨板卡槽和/或重建板卡槽、平行翼、螺丝小孔和颏孔定位槽，平行翼设有平行翼内侧面及平行翼外侧面，平行翼内侧面形态与术前模拟所需下颌骨外侧面完全贴合，螺丝小孔位于平行翼左右端部；平行翼由上平行翼和下平行翼连接构成，上平行翼和下平行翼左右两端分别连接成一体，重建板卡槽设于上平行翼和下平行翼之间，用以植入重建板；上平行翼中部设有凸起，接骨板卡槽位于凸起两侧，用于植入小型接骨板；颏孔定位槽设于上平行翼端部，与下颌骨颏孔位置相对应。A guide plate for reduction and fixation of fractures in the mandibular double-mental foramen area in the present invention that solves the above technical problems, including a guide plate body, is characterized in that it is provided with bone plate slots and/or reconstruction plate slots, parallel wings, and small screw holes And the positioning groove of the mental foramen, the parallel wing is equipped with the inner side of the parallel wing and the outer side of the parallel wing, the shape of the inner side of the parallel wing is completely fitted with the outer side of the mandible required for the preoperative simulation, and the screw holes are located at the left and right ends of the parallel wing; parallel The wing is composed of an upper parallel wing and a lower parallel wing, the left and right ends of the upper parallel wing and the lower parallel wing are respectively connected into one body, and the reconstruction plate slot is provided between the upper parallel wing and the lower parallel wing for implanting the reconstruction plate; There is a protrusion in the middle of the upper parallel wing, and the bone plate slots are located on both sides of the protrusion for implanting small bone plates; the mental hole positioning groove is set at the end of the upper parallel wing, corresponding to the position of the mandibular mental hole.
螺丝小孔位于导板的两侧，用于术中固定导板；颏孔定位槽设在平行翼上边的两侧，用于术中准确定位颏孔，避免术中损伤到颏神经等重要解剖结构，因为下牙槽神经、血管从下颌孔进入下颌管向前走行，在颏孔处分出颏神经及血管，需要避免被损伤。The small screw holes are located on both sides of the guide plate, which are used to fix the guide plate during the operation; the mental foramen positioning grooves are set on both sides of the upper side of the parallel wing, which are used to accurately locate the mental foramen during the operation, and avoid damage to important anatomical structures such as the mental nerve during the operation. Because the inferior alveolar nerve and blood vessels enter the mandibular canal from the mandibular foramen and run forward, and branch off the mental nerve and blood vessels at the mental foramen, it is necessary to avoid being damaged.
根据骨折手术类型，如果骨折手术需要同时用重建板和小型接骨板，则同时设有接骨板卡槽和重建板卡槽。According to the fracture operation type, if the fracture operation needs to use the reconstruction plate and the small bone bone plate at the same time, the bone bone plate slot and the reconstruction plate slot are provided at the same time.
所述接骨板卡槽和重建板卡槽为空心，长和宽与预成形后的小型接骨板或重建板长宽度相符，接骨板卡槽和重建板卡槽用于术中放置小型接骨板和重建板，引导小型接骨板和重建板就位。The bone plate slot and the reconstruction plate slot are hollow, and the length and width are consistent with the length and width of the preformed small bone plate or reconstruction plate. The bone plate slot and the reconstruction plate slot are used for placing small bone plates and Reconstruction Plates, Guide Mini Plates and Reconstruction Plates into place.
平行翼左右端为重建板卡槽的边缘，离重建板边缘距离0.8-1.2cm，增强导板的稳固性，平行翼整体是贴合骨面设计。人体下颌骨下缘是一个曲线的形状，下平行翼底边相应为一个曲线的形状。The left and right ends of the parallel wings are the edges of the reconstruction plate slot, and the distance from the edge of the reconstruction plate is 0.8-1.2cm to enhance the stability of the guide plate. The parallel wings are designed to fit the bone surface as a whole. The lower edge of the human mandible is in the shape of a curve, and the bottom edge of the lower parallel wing is correspondingly in the shape of a curve.
所述接骨板卡槽与牙根端位置距离≥5mm。本发明中所述接骨板卡槽和重建板卡槽需避开颏孔区，在骨折线两端预留两个钛钉孔长度的接骨板卡槽，位于牙根下至少的5mm位置。The distance between the bone plate slot and the tooth root end is ≥5mm. The bone plate slot and the reconstruction plate slot in the present invention need to avoid the mental foramen area, and two bone plate slots with the length of titanium nail holes are reserved at both ends of the fracture line, located at least 5mm below the tooth root.
所述颏孔定位槽2个，分别设于上平行翼左右端部，与下颌骨两个颏孔位置相对应。两边的颏孔定位槽的形状可以不一样，目的都是让开颏孔的位置，下颌骨上的颏孔位置在什么地方，颏孔定位槽开口就在其相对应的位置。The two mental foramen positioning grooves are respectively arranged at the left and right ends of the upper parallel wing, corresponding to the positions of the two mental foramen of the mandible. The shape of the mental foramen positioning grooves on both sides can be different, the purpose is to get out of the position of the mental foramen, where the mental foramen is located on the mandible, the opening of the mental foramen positioning groove is at its corresponding position.
所述下平行翼底边设有下平行翼缘，为不规则曲线，内扣进入下颌骨下缘，向内延展，形态与术前模拟所需下颌骨下缘完全贴合；起到固定的作用。下平行翼缘内扣绕到下颌骨内侧去，方便固位，下颌骨形态完全贴合的，绕到下颌骨内侧的内扣宽度为2-3mm。The bottom edge of the lower parallel wing is provided with a lower parallel flange, which is an irregular curve. The inner buckle enters the lower edge of the mandible and extends inward. effect. The inner buckle of the lower parallel flange is wrapped around the inner side of the mandible, which is convenient for retention. If the shape of the mandible is completely fitted, the width of the inner buckle wrapped around the inner side of the mandible is 2-3mm.
所述平行翼厚度为1.8-2.1mm，优化方案中为2.0mm。辅助复位固定骨折断端，还可以辅助导板在颌骨上的固定。The thickness of the parallel wings is 1.8-2.1 mm, which is 2.0 mm in the optimization scheme. Auxiliary reduction and fixation of the broken end of the fracture can also assist the fixation of the guide plate on the jaw.
所述螺丝小孔直径为2-2.3mm，优化方案中为2.2mm。螺丝小孔位于导板的两侧，用于术中固定导板。The diameter of the small screw hole is 2-2.3 mm, which is 2.2 mm in the optimal solution. Small screw holes are located on both sides of the guide plate for fixing the guide plate during operation.
所述导板还设有加固杆，加固杆一端与上平行翼连接，一端与下平行翼相连。加固杆连接上平行翼和下平行翼，起到加固的作用。The guide plate is also provided with a reinforcing rod, one end of the reinforcing rod is connected with the upper parallel wing, and the other end is connected with the lower parallel wing. The reinforcing bar connects the upper parallel wing and the lower parallel wing to play the role of reinforcement.
所述加固杆呈弯曲的圆柱形，设在平行翼中部。加固杆与平行翼外侧面连接可为固定式，即加固杆两端与平行翼固定成一体，制作时也成一体。也可为活动式连接。不同的平行翼，使用相同模式的加固杆，节省材料，降低成本。The reinforcing rod is in the shape of a curved cylinder and is arranged in the middle of the parallel wings. The connection between the reinforcement rod and the parallel wing outer surface can be fixed, that is, the two ends of the reinforcement rod and the parallel wings are fixed into one, and are also integrated during manufacture. Active connections are also possible. Different parallel wings, using the same pattern of reinforcing rods, saving materials and reducing costs.
本发明可在术前将导板固定在下颌骨模型上，根据板槽的长度进行钛板预成形，节省术中钛板成形的时间，术中将复位固定导板安放在下颌骨上后根据平行翼上的螺丝小孔在下颌骨上钻孔，再使用9mm长，直径1.5mm的钛钉将复位固定导板固定在下颌骨上，从而使复位固定导板和下颌骨形成一个整体，指导骨折断端的复位，并且辅助固定骨折断端。然后将术前预成形的钛板准确的放置在板槽内，植入钛钉固定钛板后，取下复位固定导板，这样就达到了精准治疗的目的。The present invention can fix the guide plate on the mandible model before the operation, preform the titanium plate according to the length of the plate groove, save the time for forming the titanium plate during the operation, and place the reset and fixed guide plate on the mandible bone during the operation according to the parallel wings. The small screw holes on the upper jaw are drilled on the mandible, and then the reduction and fixation guide plate is fixed on the mandible with 9mm long and 1.5mm diameter titanium nails, so that the reduction and fixation guide plate and the mandible form a whole to guide the fracture end. Reduction and auxiliary fixation of the fractured end. Then the pre-operative pre-formed titanium plate is accurately placed in the plate groove, and after the titanium nail is implanted to fix the titanium plate, the reset and fixation guide plate is removed, thus achieving the goal of precise treatment.
本发明中复位固定导板结构简单，设计简便，3D打印成本低，操作简便，有利于颌面外科医生在术中复位并固定复杂的下颌骨骨折，从而达到精确化手术的目标，并达到降低手术难度，缩短手术时间的目的。且对临床人员稍加训练即可自行设计；在临床使用上，简单易用，稍加说明即可熟练应用，在术中，定位精准，大大提高了手术的精准度，同时术前预成形的钛板可以轻松就位，省去了术中预成形钛板的时间，手术时间平均缩短了约40-50分钟，明显提高了手术效率。The reset and fixation guide plate in the present invention has simple structure, simple design, low cost of 3D printing, and easy operation, which is beneficial for maxillofacial surgeons to reset and fix complex mandibular fractures during surgery, thereby achieving the goal of precise surgery and reducing the cost of surgery. Difficulty, the purpose of shortening the operation time. And it can be designed by the clinical staff with a little training; in clinical use, it is easy to use, and can be used proficiently with a little explanation; during the operation, the positioning is accurate, which greatly improves the accuracy of the operation. The titanium plate can be easily placed in place, which saves the time of preforming the titanium plate during the operation, shortens the operation time by about 40-50 minutes on average, and significantly improves the operation efficiency.
附图说明Description of drawings
图1为本发明中复位固定导板结构示意图Fig. 1 is the structure schematic diagram of resetting and fixing guide plate in the present invention
图2为本发明中复位固定导板术中结构示意图Fig. 2 is a schematic diagram of the intraoperative structure of the reduction and fixation guide plate in the present invention
其中，图中标识具体为：1.接骨板卡槽,2.重建板卡槽，3. 平行翼,4.螺丝小孔,5.加固杆,6. 上平行翼，7. 下平行翼,8.平行翼外侧面,9.平行翼内侧面,10.下颌骨外侧面,11.颏孔定位槽，12.下平行翼缘，13.小型接骨板，14. 重建板，15. 颏孔Among them, the specific marks in the figure are: 1. Bone plate slot, 2. Reconstruction plate slot, 3. Parallel wing, 4. Screw hole, 5. Reinforcement rod, 6. Upper parallel wing, 7. Lower parallel wing, 8. Parallel wing lateral surface, 9. Parallel wing medial surface, 10. Mandible lateral surface, 11. Mental foramen positioning groove, 12. Lower parallel flange, 13. Small bone plate, 14. Reconstruction plate, 15. Mental foramen
具体实施方式Detailed ways
下面结合具体实施方式对本发明进行进一步说明：The present invention will be further described below in conjunction with specific embodiment:
实施例1Example 1
一种下颌骨双颏孔区骨折复位固定导板，设有接骨板卡槽和重建板卡槽、平行翼、螺丝小孔和颏孔定位槽，平行翼设有平行翼内侧面及平行翼外侧面，平行翼内侧面形态与术前模拟所需下颌骨外侧面完全贴合，螺丝小孔位于平行翼左右端部；平行翼由上平行翼和下平行翼连接构成，上平行翼和下平行翼左右两端分别连接成一体，重建板卡槽设于上平行翼和下平行翼之间，用以植入重建板；上平行翼中部设有凸起，接骨板卡槽位于凸起两侧，用于植入小型接骨板；颏孔定位槽设于上平行翼端部，与下颌骨颏孔位置相对应。A guide plate for reduction and fixation of fractures in the double mental foramen region of the mandible, which is provided with bone bone plate slots and reconstruction plate slots, parallel wings, screw holes and mental hole positioning slots, and the parallel wings are provided with parallel wing inner surfaces and parallel wing outer surfaces , the shape of the medial side of the parallel wing fits perfectly with the outer side of the mandible required for the preoperative simulation, and the screw holes are located at the left and right ends of the parallel wing; the parallel wing is composed of the upper parallel wing and the lower parallel wing, and the upper parallel wing and the lower parallel wing The left and right ends are respectively connected into one body, and the reconstruction plate slot is set between the upper parallel wing and the lower parallel wing for implanting the reconstruction plate; there is a protrusion in the middle of the upper parallel wing, and the bone plate slot is located on both sides of the protrusion. It is used to implant a small bone plate; the positioning groove of the mental hole is set at the end of the upper parallel wing, corresponding to the position of the mental hole of the mandible.
接骨板卡槽和重建板卡槽为空心，长和宽与预成形后的小型接骨板或重建板长宽度相符，接骨板卡槽和重建板卡槽用于术中放置小型接骨板和重建板，引导小型接骨板和重建板就位。The bone plate slot and reconstruction plate slot are hollow, and the length and width match the length and width of the preformed small bone plate or reconstruction plate. The bone plate slot and reconstruction plate slot are used for placing small bone plates and reconstruction plates during surgery , to guide the small bone plate and reconstruction plate into position.
卡槽的位置是根据病人骨折类型变化的，本实施例中因为重建板是沿下颌骨下缘摆放，而小型的接骨板是在牙根尖下5mm的位置摆放，卡槽也就在对应的位置了。卡槽的形状大小都是根据接骨板的不同有灵活变化的，本实施例中两边用的是一样的接骨板，所以形状、大小是相似的，如图2。The position of the slot varies according to the fracture type of the patient. In this example, because the reconstruction plate is placed along the lower edge of the mandible, and the small bone plate is placed 5 mm below the root tip of the tooth, the slot is also located at the corresponding position. location. The shape and size of the slots can be flexibly changed according to the different bone plates. In this embodiment, the same bone plate is used on both sides, so the shape and size are similar, as shown in Figure 2.
平行翼左右端为重建板卡槽的边缘，离重建板边缘距离0.8或1.2cm，增强导板的稳固性，平行翼整体是贴合骨面设计。人体下颌骨下缘是一个曲线的形状，下平行翼底边相应为一个曲线的形状。The left and right ends of the parallel wings are the edges of the reconstruction plate slot, and the distance from the edge of the reconstruction plate is 0.8 or 1.2cm to enhance the stability of the guide plate. The parallel wings are designed to fit the bone surface as a whole. The lower edge of the human mandible is in the shape of a curve, and the bottom edge of the lower parallel wing is correspondingly in the shape of a curve.
接骨板卡槽与牙根端位置距离≥5mm。颏孔定位槽2个，分别设于上平行翼左右端部，与下颌骨两个颏孔位置相对应。The distance between the bone plate slot and the root end is ≥5mm. There are two mental foramen positioning grooves, which are respectively located at the left and right ends of the upper parallel wing, corresponding to the two mental foramen positions of the mandible.
下平行翼底边设有下平行翼缘，为不规则曲线，内扣进入下颌骨下缘，向内延展，形态与术前模拟所需下颌骨下缘完全贴合；起到固定的作用。下平行翼缘内扣绕到下颌骨内侧去，方便固位，下颌骨形态完全贴合的，绕到下颌骨内侧的内扣宽度为2或3mm。The bottom edge of the lower parallel wing is provided with a lower parallel flange, which is an irregular curve. The inner buckle enters the lower edge of the mandible and extends inward. The inner buckle of the lower parallel flange is wrapped around the inner side of the mandible to facilitate retention. If the shape of the mandible fits perfectly, the width of the inner buckle wrapped around the inner side of the mandible is 2 or 3 mm.
平行翼厚度为2或2.5mm，辅助复位固定骨折断端，还可以辅助导板在颌骨上的固定。The thickness of the parallel wings is 2 or 2.5mm, which can assist reduction and fixation of the fractured end, and can also assist the fixation of the guide plate on the jaw.
螺丝小孔直径为2mm，螺丝小孔位于导板的两侧，用于术中固定导板。The diameter of the screw holes is 2mm, and the screw holes are located on both sides of the guide plate, which are used to fix the guide plate during the operation.
实施例2Example 2
一种下颌骨双颏孔区骨折复位固定导板，设有接骨板卡槽或重建板卡槽、平行翼、螺丝小孔、加固杆和颏孔定位槽，平行翼设有平行翼内侧面及平行翼外侧面，平行翼内侧面形态与术前模拟所需下颌骨外侧面完全贴合，螺丝小孔位于平行翼左右端部；平行翼由上平行翼和下平行翼连接构成，上平行翼和下平行翼左右两端分别连接成一体，重建板卡槽设于上平行翼和下平行翼之间，用以植入预成形重建板；上平行翼中部设有凸起，小型接骨板卡槽位于凸起两侧，用于植入小型接骨板；颏孔定位槽设于上平行翼端部，与下颌骨颏孔位置相对应；加固杆一端与上平行翼连接，一端与下平行翼相连。加固杆连接上平行翼和下平行翼，起到加固的作用。加固杆呈弯曲的圆柱形，设在平行翼中部。加固杆与平行翼外侧面连接可为固定式，即加固杆两端与平行翼固定成一体，制作时也成一体。也可为活动式连接。不同的平行翼，使用相同模式的加固杆，节省材料，降低成本。A guide plate for reduction and fixation of fractures in the double mental foramen area of the mandible, which is provided with slots for bone bone plates or reconstruction plates, parallel wings, small screw holes, reinforcing rods, and positioning slots for mental foramen, and the parallel wings are provided with inner surfaces of parallel wings and parallel wings. The outer side of the wing and the inner side of the parallel wing fit perfectly with the outer side of the mandible required for the preoperative simulation, and the screw holes are located at the left and right ends of the parallel wing; The left and right ends of the lower parallel wing are respectively connected into one body, and the reconstruction plate slot is set between the upper parallel wing and the lower parallel wing for implanting a preformed reconstruction plate; there is a protrusion in the middle of the upper parallel wing, and a small bone plate slot Located on both sides of the protrusion, it is used to implant a small bone plate; the mental hole positioning groove is set at the end of the upper parallel wing, corresponding to the position of the mandibular mental hole; one end of the reinforcement rod is connected with the upper parallel wing, and the other end is connected with the lower parallel wing . The reinforcing bar connects the upper parallel wing and the lower parallel wing to play the role of reinforcement. The reinforcing rod is in the shape of a curved cylinder and is located in the middle of the parallel wings. The connection between the reinforcement rod and the parallel wing outer surface can be fixed, that is, the two ends of the reinforcement rod and the parallel wings are fixed into one, and are also integrated during manufacture. Active connections are also possible. Different parallel wings, using the same pattern of reinforcing rods, saving materials and reducing costs.
接骨板卡槽和重建板卡槽为空心，长和宽与预成形后的小型接骨板和重建板长宽度相符，小型接骨板卡槽和重建板卡槽用于术中放置小型接骨板和重建板，引导小型接骨板和重建板就位。The bone bone plate and reconstruction plate slots are hollow, and the length and width match the length and width of the preformed small bone bone plate and reconstruction plate. The small bone bone plate and reconstruction plate slots are used for intraoperative placement of small bone plates and reconstruction plate to guide the miniature bone plate and reconstruction plate into place.
平行翼左右端为重建板卡槽的边缘，离重建板边缘距离1cm，增强导板的稳固性，平行翼整体是贴合骨面设计。人体下颌骨下缘是一个曲线的形状，下平行翼底边相应为一个曲线的形状。The left and right ends of the parallel wings are the edges of the reconstruction plate slot, and the distance from the edge of the reconstruction plate is 1cm to enhance the stability of the guide plate. The parallel wings are designed to fit the bone surface as a whole. The lower edge of the human mandible is in the shape of a curve, and the bottom edge of the lower parallel wing is correspondingly in the shape of a curve.
接骨板卡槽与牙根端位置距离≥5mm。本发明中所述接骨板卡槽和重建板卡槽需避开颏孔区，在骨折线两端预留两个钛钉孔长度的接骨板卡槽，位于牙根下至少的5mm位置。The distance between the bone plate slot and the root end is ≥5mm. The bone plate slot and the reconstruction plate slot in the present invention need to avoid the mental foramen area, and two bone plate slots with the length of titanium nail holes are reserved at both ends of the fracture line, located at least 5mm below the tooth root.
颏孔定位槽2个，分别设于上平行翼左右端部，与下颌骨两个颏孔位置相对应。两边的颏孔定位槽的形状可以不一样，目的是让开颏孔的位置，定位槽位置与下颌骨上颏孔位置相符合。There are two mental foramen positioning grooves, which are respectively located at the left and right ends of the upper parallel wing, corresponding to the two mental foramen positions of the mandible. The shape of the mental foramen positioning grooves on both sides can be different, the purpose is to get rid of the position of the mental foramen, and the position of the positioning grooves is consistent with the position of the mental foramen on the mandible.
下平行翼底边设有下平行翼缘，为不规则曲线，内扣进入下颌骨下缘，向内延展，形态与术前模拟所需下颌骨下缘完全贴合；起到固定的作用。下平行翼缘内扣绕到下颌骨内侧去，方便固位，与下颌骨形态完全贴合，绕到下颌骨内侧的内扣宽度为3mm。The bottom edge of the lower parallel wing is provided with a lower parallel flange, which is an irregular curve. The inner buckle enters the lower edge of the mandible and extends inward. The inner buckle of the lower parallel flange is wrapped around the inner side of the mandible, which is convenient for retention and fully fits the shape of the mandible. The width of the inner buckle wrapped around the inner side of the mandible is 3mm.
平行翼厚度为2.0mm。辅助复位固定骨折断端，还可以辅助导板在颌骨上的固定。The thickness of the parallel wings is 2.0 mm. Auxiliary reduction and fixation of the broken end of the fracture can also assist the fixation of the guide plate on the jaw.
螺丝小孔直径为2.2mm。螺丝小孔位于导板的两侧，用于术中固定导板。The screw hole diameter is 2.2mm. Small screw holes are located on both sides of the guide plate for fixing the guide plate during operation.
本发明导板为可精准辅助治疗下颌骨双颏孔区粉碎性骨折的3D打印个性化复位固定导板，通过在导板上设计出放置预成形钛板的凹槽，术前即可在凹槽以及颌骨模型上进行钛板的预成形，术中板槽还可指导钛板的放置，既减少了误差，同时也达到了辅助骨折精确复位的目的，有助于重建患者良好的面型及生理功能。The guide plate of the present invention is a 3D printed personalized reduction and fixation guide plate that can accurately assist in the treatment of comminuted fractures in the double mental foramen area of the mandible. The titanium plate is preformed on the bone model, and the plate groove can also guide the placement of the titanium plate during the operation, which not only reduces the error, but also achieves the purpose of assisting the accurate reduction of the fracture, and helps to reconstruct the patient's good facial shape and physiological function .
两个颏孔定位槽是因为每个人都有左右两个颏孔。下颌管在第一、第二前磨牙牙根之间向外穿出一孔，称颏孔。颏孔处有颏神经血管束走行，手术的时候必须要避开这个位置。The reason for the two mental holes is because everyone has left and right mental holes. The mandibular canal pierces a hole between the roots of the first and second premolars, called the mental foramen. The mental neurovascular bundle runs at the mental foramen, and this location must be avoided during surgery.
在术前根据板槽及下颌骨模型对小型接骨板、重建板进行预成形，节省术中钛板成形的时间，术中将复位固定导板安放在下颌骨上后根据平行翼上的螺丝小孔在下颌骨上钻孔，再使用7mm长，直径1.5mm的钛钉将复位固定导板固定在下颌骨上，从而使复位固定导板和下颌骨形成一个整体，指导骨折断端的复位，并且辅助固定骨折断端。然后将术前预成形的钛板准确的放置在板槽内，植入钛钉固定钛板后，取下复位固定导板，这样就达到了精准治疗的目的。Preform the small bone plate and reconstruction plate according to the plate groove and mandible model before operation, saving the time of titanium plate forming during operation, and place the reduction and fixation guide plate on the mandible during operation according to the screw holes on the parallel wing Drill a hole on the mandible, and then use 7mm long and 1.5mm diameter titanium nails to fix the reduction and fixation guide plate on the mandible, so that the reduction and fixation guide plate and the mandible form a whole, guide the reduction of the broken end of the fracture, and assist in fixation Broken ends. Then the pre-operative pre-formed titanium plate is accurately placed in the plate groove, and after the titanium nail is implanted to fix the titanium plate, the reset and fixation guide plate is removed, thus achieving the goal of precise treatment.
试验一test one
患者男，41岁，患者面形不对称，双侧下颌明显肿胀，面下份伸长，双下颌骨体部压痛（+），可扪及骨台阶感，张口受限，张口度约两横指，咬合关系错乱，双侧后牙早接触，余牙开合。术中将患者下颌骨骨折初步解剖复位后，将复位固定导板放置于双侧下颌骨上，植入术前预成形的小型接骨板及重建板，可见钛板就位良好，与下颌骨骨面贴合可。重新拼对咬合关系，植入咬合导板，行颌间牵引，见患者咬合恢复良好。术后1月患者面部肿胀基本消退，伤口愈合，面部外形基本对称，咬合关系恢复良好，复查CT提示所有钛板就位良好。The patient was a 41-year-old male patient with asymmetrical facial shape, obvious swelling of bilateral mandibles, elongation of the lower part of the face, tenderness (+) in the body of both mandibles, palpable bony step feeling, limited mouth opening, and the degree of mouth opening was about two horizontal Refers to, the occlusal relationship is disordered, the bilateral posterior teeth are in early contact, and the remaining teeth are open and closed. After the initial anatomical reduction of the patient's mandibular fracture, the reduction and fixation guide plate was placed on the bilateral mandible, and the pre-formed small bone plate and reconstruction plate were implanted. It can be seen that the titanium plate is in place well, and the mandibular bone surface Fitting possible. The occlusal relationship was re-aligned, the occlusal guide was implanted, and the interjaw traction was performed. It was found that the patient's occlusal recovery was good. One month after the operation, the patient's facial swelling basically subsided, the wound healed, the facial shape was basically symmetrical, and the occlusal relationship recovered well. The re-examination CT showed that all the titanium plates were in place.
试验二Test two
2016年6月-2018年8月于四川大学华西口腔医院治疗的下颌骨双颏孔区骨折患者中共有19例患者使用了本发明。在术后复查随访中，19例患者术后均未出现明显下唇麻木等症状。术后1月复查，19例患者的咬合关系均恢复良好，其中18例患者的伤口愈合良好，面型基本对称，仅有1例患者出现了术区伤口感染，持续肿胀流脓的症状。追踪该患者病史发现，患者受伤时口内黏膜就有破损，形成了口内外贯通伤，由于当地医疗条件受限，未及时行清创缝合，术前就有明显的感染流脓症状。From June 2016 to August 2018, a total of 19 patients with fractures in the mandibular double mental foramen treated at the West China Stomatological Hospital of Sichuan University used the present invention. During postoperative follow-up, none of the 19 patients had obvious lower lip numbness and other symptoms. One month after the operation, the occlusal relationship of 19 patients all recovered well, and the wounds of 18 patients healed well, and the facial shape was basically symmetrical. Only 1 patient had wound infection in the operation area and symptoms of continuous swelling and pus. Following the patient's medical history, it was found that the oral mucosa was damaged when the patient was injured, forming a penetrating injury inside and outside the mouth. Due to the limited local medical conditions, debridement and suture were not performed in time, and there were obvious symptoms of infection and pus before the operation.
试验结果表明，本发明中的个性化复位固定导板，大大提高了下颌骨双颏孔区骨折的手术成功率，减少了术后并发症（如：颏神经症状，术区感染等）的出现几率。The test results show that the personalized reduction and fixation guide plate of the present invention greatly improves the success rate of mandibular bimental foramen fracture operation and reduces the occurrence of postoperative complications (such as mental nerve symptoms, infection in the operation area, etc.) .
本发明中个性化复位固定导板制作过程包括获取患者的颌骨螺旋CT数据、虚拟手术设计、复位固定导板的设计及快速打印复位固定导板等步骤。The manufacturing process of the personalized reset and fixation guide plate in the present invention includes the steps of obtaining the patient's maxillary spiral CT data, virtual surgery design, design of the reset and fixation guide plate, rapid printing of the reset and fixation guide plate, and the like.
（1）获取患者颌骨螺旋CT数据：患者螺旋CT扫描层厚至多为1mm，扫描范围包括整个颅颌面部骨骼，数据存贮格式为DICOM格式。(1) Obtain spiral CT data of the patient's jaw: the slice thickness of the patient's spiral CT scan is at most 1 mm, the scanning range includes the entire craniofacial skeleton, and the data storage format is DICOM format.
（2）虚拟手术设计：将获取的颌骨DICOM数据导入三维建模软件-MIMCS17.0(Materialise,比利时)重建颌骨三维模型；在CT断层上进行操作，分割出下颌骨；解剖复位下颌骨；将两侧下颌骨块三维模型保存为STL格式文件。(2) Virtual surgery design: Import the acquired DICOM data of the jaw into the 3D modeling software-MIMCS17.0 (Materialise, Belgium) to reconstruct the 3D model of the jaw; operate on the CT slice to segment the mandible; anatomically reset the mandible ;Save the 3D models of the mandible blocks on both sides as STL format files.
（3）复位固定导板的设计：将STL格式文件导入3-Matic 9.0，选择两侧下颌骨靠近断端骨块区域为感兴趣区域，将该区域单独分割出来，利用Offset功能将面数据转化为2mm厚度的体数据，保存为STL，再将该STL文件导入MIMICS17.0中。在MIMICS17.0软件中，利用Medcad功能设计匹配接骨板和重建板长度的模型，利用布朗运算功能，用导板减去该模型，设计出板槽，再用Medcad功能设计出加固杆连接平行翼上下缘。(3) Design of reset and fixation guide plate: Import the STL format file into 3-Matic 9.0, select the area of interest of the mandible on both sides near the broken end, segment the area separately, and use the Offset function to convert the surface data into The volume data with a thickness of 2mm is saved as STL, and then the STL file is imported into MIMICS17.0. In MIMICS17.0 software, use the Medcad function to design the model of the matching bone plate and reconstruction plate length, use the Brownian operation function, subtract the model with the guide plate, design the plate groove, and then use the Medcad function to design the reinforcement bar connecting the upper and lower sides of the parallel wing edge.
（4）3D打印复位固定导板：将导板数据导入3D打印设备，打印材料需为可进行冷光低温消毒的高分子无毒的材料，加工制作成复位固定导板实体。(4) 3D printing reset fixed guide plate: import the guide plate data into the 3D printing equipment, the printing material must be a non-toxic polymer material that can be sterilized by cold light and low temperature, and process it into a reset fixed guide plate entity.
以上所述仅为本发明的优选实施例，对本发明而言仅是说明性的，而非限制性的；本领域普通技术人员理解，在本发明权利要求所限定的精神和范围内可对其进行许多改变，修改，甚至等效变更，但都将落入本发明的保护范围内。The above description is only a preferred embodiment of the present invention, and it is only illustrative of the present invention, rather than restrictive; those of ordinary skill in the art understand that it can be used within the spirit and scope defined by the claims of the present invention. Many changes, modifications, and even equivalent changes can be made, but all will fall within the protection scope of the present invention.
以上显示和描述了本发明的基本原理和主要特征以及本发明的优点，上述实施例和说明书所描述的只是说明本发明的原理，在不脱离本发明精神和范围的前提下，本发明还会有各种变化和改进，这些变化和改进都将落入要求保护的本发明范围内。本发明要求保护的范围由所附的权利要求书及其等效物界定。The basic principles and main features of the present invention and the advantages of the present invention have been shown and described above. What the above-mentioned embodiments and description describe are only to illustrate the principles of the present invention. Without departing from the spirit and scope of the present invention, the present invention will also There are various changes and improvements which will fall within the scope of the claimed invention. The scope of the claimed invention is defined by the appended claims and their equivalents.
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201910054431.9ACN109620380B (en) | 2019-01-21 | 2019-01-21 | A guide plate for reduction and fixation of mandibular double mental foramen fractures |
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201910054431.9ACN109620380B (en) | 2019-01-21 | 2019-01-21 | A guide plate for reduction and fixation of mandibular double mental foramen fractures |
| Publication Number | Publication Date |
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| CN109620380A CN109620380A (en) | 2019-04-16 |
| CN109620380Btrue CN109620380B (en) | 2023-08-25 |
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CN201910054431.9AActiveCN109620380B (en) | 2019-01-21 | 2019-01-21 | A guide plate for reduction and fixation of mandibular double mental foramen fractures |
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