3D打印耳廓模型在耳廓再造软骨支架雕刻成形中的应用

doi:10.13481/j.1671-587X.20230328

摘要/Abstract

摘要：

目的探讨3D打印耳廓模型（耳模）在耳廓再造术中的应用及其对再造耳廓对称性和精准性的影响，为评价3D耳模的临床应用提供依据。方法回顾性分析采用耳廓再造术治疗单侧小耳畸形76例患者的临床资料。术前CT扫描健侧耳廓，获得DICOM文件，通过镜像和平滑处理后转化为光固化立体造型术（STL）文件，输入3D打印机后，打印出与健侧耳廓外形一致的3D耳模。所有患者均采用Nagata法行耳廓再造术。第一期手术以肋软骨为材料，参照3D打印耳模，精细雕刻再造耳廓支架；第二期手术参照3D打印耳模，提升再造耳廓，形成耳颅沟。术后随访时间6~12个月，测量并比较再造耳廓和健侧耳廓的长度和宽度，耳甲腔的长度、宽度和深度及三角窝的深度和耳颅角。调查患者对再造耳廓位置、大小、耳颅角、对称性和稳定性的满意度，计算患者满意率。结果 76例患者获得术后随访，所有再造耳廓均全部成活。患者及其家属对再造耳廓的对称性满意率达到85.5%，对大小、位置及稳定性满意率均>90%，对耳颅角的满意率为68.4%，平均满意率达到87.4%。与健侧耳廓比较，再造耳廓的长度和宽度、耳甲腔长度、宽度和深度及三角窝深度差异无统计学意义（P>0.05）。与健侧耳廓比较，再造耳廓的耳颅角缩小（P=0.014 1）。再造耳廓和健侧耳廓外形相似度较高，耳廓精细结构的相似度也较高。结论基于3D打印技术的3D打印耳模可使再造耳廓与健侧耳廓高度相似，值得临床推广应用。

关键词: 3D打印技术, 耳廓再造术, 小耳畸形, 耳廓支架, 软骨支架

Abstract:

Objectives To discuss the application of 3D printing auricular model in auricle reconstruction surgery and its effect on the symmetry and accuracy of the reconstructed auricles，and to provide the basis for evaluation on the clinical application of 3D auricular model. Methods A retrospective analysis was conducted on the clinical data of 76 patients with unilateral microtia treated with auricular reconstruction surgery.The normal auricle was scanned by the pre-operative CT to obtain the DICOM files， which were transformed into the light cured stereolithography （STL） files after mirroring and smoothing treatment. After being input into the 3D printer， the 3D auricular model which was consistent with the shape of normal auricle was printed. All the patients underwent the auricle reconstruction surgery by Nagata method. The first phase of the surgery was performed by using the costal cartilage as the material， the auricle scaffold was reconstructed and fine carved according to the 3D printing auricular model； the second phase of the surgery was enhancing the reconstructed auricle and forming the otocranial sulcus according to the 3D printing auricular model. The postoperative follow-up time was 6－12 months， and the length and width of the reconstructed and normal auricles，the length， width and depth of the conchal cavity， depth of the triangular fossa， and the cranioauricular angle were measured and compared. The satisfaction degrees of the patients with the position， size， cranioauricular angle， symmetry， and stability of the reconstructed auricles were investigated， and the satisfaction rates of the patient were calculated. Results A total of 76 patients received postoperative follow-up and all the reconstructed auricles were survived. The satisfaction rates of the patients and their families for the symmetry of the reconstructed auricle reached 85.5%， and the satisfaction rates for the size， position， and stability were all > 90%， the satisfaction rate for the otocranial angle was 68.4%， and the average satisfaction rate was 87.4%. Compared with healthy side auricle， there were no statistically significant differences in the length and width of the reconstructed auricle， the length and depth of the conchal cavity， and the depth of the triangular fossa （P>0.05）. Compared with healthy side auricle，the otocranial angle of the reconstructed auricle was significantly decreased（P=0.014 1）. The similarity of shape between the reconstructed auricle and the healthy side auricle was high， and the similarity of fine structure of the auricle was also high. Conclusion The 3D printing auricular models based on the 3D printing technology can make the reconstructed auricle to be similar highly with the healthy side auricle， and it is worth to apply in the clinical treatment.

Key words: Three-dimensional printing technology, Auricle reconstruction, Microtia, Auricular scaffold, Auricle reconstruction

中图分类号:

R764.9

李腾海,杨田野,彭维海. 3D打印耳廓模型在耳廓再造软骨支架雕刻成形中的应用[J]. 吉林大学学报(医学版), 2023, 49(3): 770-776.

Tenghai LI,Tianye YANG,Weihai PENG. Application of 3D printing auricular model in carving and shaping of cartilage scaffold in auricle reconstruction[J]. Journal of Jilin University(Medicine Edition), 2023, 49(3): 770-776.

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Group	Length of auricle（l/mm）	Width auricle（l/mm）	Length of concha（l/mm）	Width of concha（l/mm）	Depth of concha（l/mm）	Depth of triangular fossa（l/mm）	Cranioauricular angle(θ/°)
Normal auricle	60.9±4.1	33.2±2.7	24.1±3.3	14.5±3.5	14.8±3.4	6.5±1.3	38.3±4.7
Reconstructive auricle	61.8±4.3	31.9±2.9	23.6±3.5	13.9±3.2	14.1±3.9	6.8±1.1	32.5±5.2
P	0.634 9	0.124 8	0.511 5	0.556 4	0.785 4	0.645 6	0.014 1