数字化设计联合多种材料修复颅颌面骨缺损1例报告及文献回顾OA

Objective To explore the feasibility,precision,and clinical value of a personalized primary repair ap-proach centered on digital design,integrating 3D printing technology with multiple materials such as titanium mesh,polyetheretherketone(PEEK),and titanium plates,for complex craniofacial bone defects involving the skull,mandible,orbit,and zygoma resulting from traffic accidents,providing a reference for primary repair of clinically complex craniofa-cial bone defects.Methods One patient who was admitted in September 2021 with multiple comminuted fractures of the right craniomaxillofacial region and large-area bone defects caused by a traffic accident was selected.Digital design was integrated throughout the entire repair process.First,preoperative computed tomography(CT)data were used for 3D reconstruction of the craniomaxillofacial region;then,based on the model,the anatomical contour of the healthy left side was reproduced via mirroring technology for the defects on the right side.A targeted repair plan was designed:3D-printed PEEK material was used to reconstruct the right orbital floor and zygomaticomaxillary complex,a 0.6-mm-thick titanium mesh was adopted to repair the right skull defect,and a 2.0-mm-thick titanium plate was applied for rigid inter-nal fixation of the mandibular fracture.A one-stage repair surgery was completed simultaneously.In addition,a litera-ture review was conducted on studies related to the repair of complex combined craniomaxillofacial defects.Results CT examination at 1 week postoperatively showed that the average fitting gap of the implants was 0.3 mm,and the sym-metry difference of the facial contour was less than 5 mm.At 3 months postoperatively,the patient's maximum mouth opening reached 38 mm,the occlusal relationship returned to normal,and the diplopia symptom completely disap-peared.During the 6-month postoperative follow-up,no complications such as implant loosening,infection,or displace-ment occurred;the FACE-Q scale score was 91,indicating a high level of subjective patient satisfaction.The literature review indicated that digital design combined with 3D printing technology can significantly improve the accuracy of complex craniomaxillofacial bone defect reconstruction.PEEK material is suitable for the reconstruction of the orbital floor and zygomaticomaxillary complex.Titanium mesh and plates can ensure the stability of the reconstruction.Multi-materials combined reconstruction represents an important therapeutic strategy for such defects.Conclusion The indi-vidualized one-stage repair scheme,centered on digital design and combined with 3D printing technology and multi-materials(titanium mesh,PEEK,and titanium plates),can achieve precise anatomical reduction and simultaneous func-tional recovery for complex combined craniomaxillofacial bone defects caused by traffic accidents.