CN105816219B - The nervus alverlaris protection guide plate controlled is scraped based on mandibular cystic lesion - Google Patents
The nervus alverlaris protection guide plate controlled is scraped based on mandibular cystic lesion Download PDFInfo
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- CN105816219B CN105816219B CN201610331075.7A CN201610331075A CN105816219B CN 105816219 B CN105816219 B CN 105816219B CN 201610331075 A CN201610331075 A CN 201610331075A CN 105816219 B CN105816219 B CN 105816219B
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- Prior art keywords
- guide plate
- cystic lesion
- upper limb
- edge
- cystic
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Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/1657—Bone breaking devices
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/1659—Surgical rasps, files, planes, or scrapers
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/1662—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
- A61B17/1673—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the jaw
Abstract
The present invention relates to craniofacial orthopedics medical instruments fields; more particularly to a kind of nervus alverlaris controlled of being scraped based on mandibular cystic lesion protects guide plate; including guide plate ontology; guide plate ontology is equipped with guide plate medial surface and guide plate lateral surface; the guide plate ontology is additionally provided with guide plate leading edge, guide plate rear, guide plate upper limb and retainer; guide plate leading edge and guide plate rear are respectively guide plate ontology left and right ends portion; and be equipped with cystic lesion prezone at acies before guide plate and indicate edge, boundary indicates edge after being equipped with cystic lesion at acies after guide plate；Guide plate upper limb is located at guide plate body upper end, is equipped with guide plate upper limb line at end, guide plate upper limb line morphology is bonded completely with cystic lesion lower edge needed for preoperative simulation；Retainer is located at guide plate medial surface bottom end, is in concave, and form is bonded completely with angle of mandible needed for preoperative simulation.It protects guide plate to position and protect the important anatomy structures such as nervus alverlaris in the present invention, while providing in art and instructing, guide plate is easy to operate, cheap.
Description
Technical field
The present invention relates to craniofacial orthopedics medical instruments fields more particularly to a kind of scraped based on mandibular cystic lesion to control down
Alveolar nerve protects guide plate.
Background technique
Nervus alverlaris is a branch of mandibular nerve, after mandibular nerve branch, through mandibular foramen in mandibular
Mandibular canal in traveling, summarize gum sensory nerve and most of dental nerves from lower alveolus.Finally passed in mental foramen
Become nervus mentalis out.The nervus alverlaris of mandibular cystic lesion patient is usually involved, and Ipsilateral lower lip is be easy to cause after damage
And mandibular teeth numbness and uncomfortableness, cystic lesion scaling is mostly used greatly for the treatment of such patient.Patient becomes because of itself dissection
The factors such as different and cystic lesion occupy-place cause each patient's nervus alverlaris traveling and form different, and doctor operates in art
Shi Changchang makes nerve be damaged because that can not hold the exact position of nervus alverlaris.
As digitlization surgical technic quickly grows and be widely used in surgical operation therapy, surgical template technology is in mouth
Chamber decorative sursery has certain application, and application mode is mainly osteotomy guide plate, bite guide, reduction of the fracture guide plate etc., but right
It is fewer in the research of positioning and the protection of the important anatomy structures such as nervus alverlaris.
Summary of the invention
In order to solve the above technical problems, the present invention provides a kind of nervus alverlaris guarantor for scraping and controlling based on mandibular cystic lesion
Plate is protected and led, the important anatomy structures such as nervus alverlaris are positioned and protected, while providing in art and instructing；Guide plate operation letter
Just, cheap, make to complete alone in doctor's art, is easy to clinical expansion.
A kind of nervus alverlaris controlled of being scraped based on mandibular cystic lesion of the invention for solving the above technical problem is protected
Guide plate, including guide plate ontology, guide plate ontology are equipped with guide plate medial surface and guide plate lateral surface, it is characterised in that: the guide plate ontology
It is additionally provided with guide plate leading edge, guide plate rear, guide plate upper limb and retainer, guide plate leading edge and guide plate rear are respectively guide plate ontology or so
Both ends, and be equipped with cystic lesion prezone at acies before guide plate and indicate edge, boundary indicates after being equipped with cystic lesion at acies after guide plate
Edge；Guide plate upper limb is located at guide plate body upper end, is equipped with guide plate upper limb line at end, needed for guide plate upper limb line morphology and preoperative simulation
Cystic lesion lower edge is bonded completely；Retainer is located at guide plate medial surface bottom end, is in concave, needed for form and preoperative simulation under
Jaw angle is bonded completely.
Guiding groove is additionally provided at the guide plate upper limb.
There are two the guiding groove is set, it is located at guide plate upper limb line two sides and is connect respectively with guide plate upper limb line.
The cystic lesion prezone instruction edge is concordant with cystic lesion prezone.
Boundary's instruction edge is concordant with boundary after cystic lesion after the cystic lesion.Cystic lesion prezone indicates edge: pressing protection board
Leading edge extension can be concordant with cystic lesion prezone, can hold cystic lesion prezone range according to guide plate leading edge locus in art.
Boundary indicates edge after cystic lesion: can be concordant with boundary after cystic lesion by the extension of guide plate rear, it can be according to guide plate in art
Posterior border position holds boundary's range after cystic lesion.
The guide plate thickness is 1.5-2.5mm.
Upper limb line: guide plate upper limb is bonded completely with cystic lesion lower edge, can be according to the accurate handle of guide plate upper limb form in art
Cystic lesion lower bound range is held, and instructs correct operation range in order to avoid damaging nervus alverlaris.
Guiding groove: i.e. windowing scrapes and controls guiding groove, according to cystic lesion range determine behind most suitable windowing position reserved groove with
Just Design windowing position is accurately transferred in art.
Retainer: neuroprotection guide plate extends into corner to mandibular inside along angle of mandible and lower jaw lower edge, forms guide plate
Retainer makes guide plate fixed not bias during being bonded bone face.
Protection guide plate in the present invention protects nervus alverlaris, while positioning cystic lesion, reaches functional surgery treatment
Purpose, give full play to accurate, minimally invasive, the safe feature of digitlization surgical intervention.
Detailed description of the invention
Fig. 1 is that guide plate lateral surface structural schematic diagram is protected in the present invention
Fig. 2 is that guide plate medial surface structural schematic diagram is protected in the present invention
Fig. 3 is present invention protection guide plate and mandibular combination schematic diagram
Wherein, it is identified in figure specifically: 1. guide plate ontologies, 2. guide plate medial surfaces, 3. guide plate lateral surfaces, before 4. guide plates
Edge, 5. guide plate rears, 6. guide plate upper limbs, 7. retainers, 8. cystic lesion prezones indicate edge, and boundary refers to after 9. cystic lesions
Show edge, 10. guide plate upper limb lines, 11. cystic lesion lower edges, 12. angles of mandible, 13. guiding grooves, before 14. cystic lesions
Boundary, boundary after 15. cystic lesions, 16. cystic lesions, 17. lower jaw lower edges, 18. mandibulars, 19. nervus alverlaris vascular bundles
Specific embodiment
Below by the present invention will be further described in conjunction with the embodiments, it should be understood that these embodiments are only used for
The purpose of illustration, is never limited in protection scope of the present invention.
Embodiment 1
It is a kind of to scrape the nervus alverlaris protection guide plate controlled, including guide plate ontology, guide plate ontology based on mandibular cystic lesion
Equipped with outside guide plate inner face and guide plate, it is characterised in that: the guide plate ontology is additionally provided with guide plate leading edge, guide plate rear, on guide plate
Edge and retainer, guide plate leading edge and guide plate rear are respectively guide plate ontology left and right ends portion, and are equipped with capsule before guide plate at acies
Lesion prezone indicates edge, and boundary indicates edge after being equipped with cystic lesion at acies after guide plate；Guide plate upper limb is equipped with guide plate upper limb line and draws
Guide groove, guide plate upper limb line is located at guide plate body upper end and form is bonded completely with cystic lesion lower edge needed for preoperative simulation；
Retainer is located at guide plate medial surface bottom end, is in concave, and form is bonded completely with angle of mandible needed for preoperative simulation.Guide plate thickness can be
1.5 or 2.5mm.
Upper limb line: guide plate upper limb is bonded completely with cystic lesion lower edge, can be according to the accurate handle of guide plate upper limb form in art
Cystic lesion lower bound range is held, and instructs correct operation range in order to avoid damaging nervus alverlaris.
Retainer: neuroprotection guide plate extends into corner to mandibular inside along angle of mandible and lower jaw lower edge, forms guide plate
Retainer makes guide plate fixed not bias during being bonded bone face.
Embodiment 2
It is a kind of to scrape the nervus alverlaris protection guide plate controlled, including guide plate ontology, guide plate ontology based on mandibular cystic lesion
Equipped with outside guide plate inner face and guide plate, it is characterised in that: the guide plate ontology is additionally provided with guide plate leading edge, guide plate rear, on guide plate
Edge and retainer, guide plate leading edge and guide plate rear are respectively guide plate ontology left and right ends portion, and are equipped with capsule before guide plate at acies
Lesion prezone indicates edge, and boundary indicates edge after being equipped with cystic lesion at acies after guide plate；Guide plate upper limb is equipped with guide plate upper limb line and two
A guiding groove, two guiding grooves, which are located at guide plate upper limb line two sides and connect guide plate upper limb line with guide plate upper limb line respectively, is located at guide plate
Body upper end and form is bonded completely with cystic lesion lower edge needed for preoperative simulation；Retainer is located at guide plate medial surface bottom end
Portion, is in concave, and form is bonded completely with angle of mandible needed for preoperative simulation.Guide plate thickness can be 2mm.
Cystic lesion prezone indicates that edge is concordant with cystic lesion prezone, can hold cystic disease according to guide plate leading edge locus in art
Become prezone range.Boundary's instruction edge is concordant with boundary after cystic lesion after cystic lesion, can hold capsule according to guide plate posterior border position in art
Venereal disease Bian Hou circle range.
Before or after cystic lesion boundary instruction edge be neuroprotection guide plate boundary, range covering operation area nervus alverlaris, with
It plays a protective role, top edge should be bonded cystic lesion boundary to play the role of instructing in art in the form of cystic lesion, front and back
Bounds can not excessively extend in order to avoid being difficult to place in art.
The present invention utilizes DICOM format data three-dimensional mandible reconstruction cystic lesion and lower alveolus mind based on spiral CT
Through, design nervus alverlaris protection guide plate protection nerve, it is in kind that 3D printing generates guide plate, for hand Intraoperative position cystic lesion and
Nervus alverlaris is protected, to reduce operation risk, operation precision is improved, reduces operation wound, shorten the time in hand, guarantee hand
Art effect.
The purpose of the present invention is achieved through the following technical solutions: the nervus alverlaris controlled is scraped based on mandibular cystic lesion
Protect guide plate, feature the following steps are included:
(1) CT scan is carried out to patient, obtains the head spiral CT scans of patient.
(2) the DICOM data of spiral CT are imported into three-dimensional software for editing and carries out three-dimensional reconstruction, divide simultaneously mandible reconstruction capsule
Venereal disease becomes and relevant anatomy, and nervus alverlaris and corresponding nervus alverlaris vascular bundles are described in simulation.
(3) three-dimensional measurement cystic lesion bounds and its relationship with important anatomy structure around, obtain perfect number
According to convenient for being held in art.
(4) in mandibular surface rendering cystic lesion and nervus alverlaris projection line, lower tooth is designed according to projection line range
Slot neuroprotection edges of boards circle reserve fenestration space in art, in intercepting lower jaw cheek side cortex bone in bounds, by intercepted bone
The STL data of block import geomagic studio software and carry out data surface processing, take out shell and thicken the void shaped after processing
Quasi- nervus alverlaris protects guide plate, saves as STL data.
(5) STL data are imported into 3D printer, using PLA poly-lactic acid material, is melt into product (FDM) mode and prints nerve
It protects guide plate in kind, by Low-temperature Plasma Sterilization, performs the operation spare.
(6) conventional to cut exposure bone face in operation, guide plate is located in Design region, and maintenance is stablized, and doctor is along set
Exposure cyst wall after meter windowing position removal cortical bone, strikes off cyst wall and surrounding inflammatory tissue, can accurately turn Design
It moves in art.
Embodiment 1
Patient women 44 years old, is chief complaint and is sought medical advice with " bottom right jaw swells and ache repeatedly suppurates 20 years ".Patient played bottom right jaw before 20 years
Swelling repeatedly is suppurated with pain, and it is effective during which to take orally anti-inflammatory drug.Training inspection: patient face type is asymmetric, and right side masseter area is swollen
Grand, local mucous membrane is complete in mouth, does not touch fluctuation.Lower lip is without feeling of numbness.Mouth opening and open-type are normal, occluding relation can,
It is remaining to show no obvious abnormalities.Our hospital's imageological examination shows: bottom right Maxillary Cystic Disease, includes 48 tooth of impaction.Tentative diagnosis is bottom right
Maxillary Cystic Disease.
Guide plate is placed in when applying in art, it is seen that guide plate lower edge and rear suit well, and maintenance is stablized.The institute along preoperative guide plate
Revealed cyst walls and C8 tooth are accurately exposed as shown in Design after reserved windowing position removal cortical bone, are pulled out C8, are struck off cyst wall
And surrounding inflammatory tissue.Right side nervus alverlaris is not injured in art, scrapes and controls sufficiently, previous such scaling need to intercept bone plate 3cm*
It only needs 5mm*5mm at cheek side two to open a window after 2cm application this method, operation wound is greatly decreased, operation is small from originally scheduled 2.5
When shorten to 1.5 hours.Postoperative half a year checks visible 30% region of cystic lesion and has new Bone Ingrowth, no recurrence sign.Patient is right
Side tooth and bottom right lip without pain and numbness and uncomfortableness sense, mouth inner teeth gear non-loosening.
Embodiment 2
Patient male 44 years old, is chief complaint and is sought medical advice with " jaw swelling and pain in lower-left are 3 days uncomfortable ".Left side lumpy jaw pain is bright before patient January
Aobvious, in outer court's row " lower-left abscess of jaw incision and drainage ", existing patient's swelling and pain break out again.Training inspection: patient face type is asymmetric,
Left side facial swelling is obvious, visible postoperative scar under left jaw.Local mucous membrane is completely without swelling in mouthful, lower lip without numbness and uncomfortableness sense,
Mouth opening about partly refer to, open-type is normal, occluding relation can, it is remaining to show no obvious abnormalities.Our hospital's imageological examination shows: lower left mandible capsule
Venereal disease becomes.Tentative diagnosis are as follows: lower left mandible cystic lesion is with infection.
It is placed in guide plate when applying in art, sees that guide plate good fit, maintenance are stablized, is abraded along the reserved windowing position of guide plate
0.5cm*2cm range cortical bone, exposure lower left mandible cystic lesion, strikes off cyst wall and surrounding inflammatory tissue；Intraoral incision is pulled out
D8 tooth.Right side nervus alverlaris is not injured in art, scrapes and controls sufficiently, this operation plan (amputation 2cm*4cm compared with traditional scheme
Range cortical bone) wound and patient's postoperative pain in art is greatly decreased, operating time 1 hour is saved, patient's infection and recurrence is reduced
Danger.It checks visible cystic lesion edge postoperative March and tooth socket region has new Bone Ingrowth, no recurrence and infection sign.
The left mandibular teeth of patient and lower-left lip without pain and numbness and uncomfortableness sense, mouth inner teeth gear non-loosening.
Design of digital aspect is simple and easy to do in the preoperative by the present invention, assists without professional software engineer, doctor relies on base
The preoperative idea of oneself can be directly transferred in art by the operation of this software and clinical experience.Guide plate manufacturing process cost is small, fast
Degree is fast, equipment requirement is low, and only rely on desktop grade rapid forming equipment can be completed in one hour.Conveniently have when being applied in art
Effect reduces the blindness of operation and saves the time in art.For patient, the present invention reduces postoperative nerve damage and art area
The risk of infection guarantees therapeutic effect, and cheap.It is accurate, minimally invasive, safe, quick in entire actual application, meet
The theory of functional surgery treatment.
The above description is only a preferred embodiment of the present invention, is merely illustrative for the purpose of the present invention, and not restrictive；
Those of ordinary skill in the art understand, can carry out many to it in the spirit and scope defined by the claims in the present invention and change
Become, modification or even equivalent change, but falls in protection scope of the present invention.
Claims (1)
1. a kind of scrape the nervus alverlaris protection guide plate controlled, including guide plate ontology (1), guide plate ontology based on mandibular cystic lesion
Equipped with guide plate medial surface (2) and guide plate lateral surface (3), it is characterised in that: the guide plate ontology (1) be additionally provided with guide plate leading edge (4),
Guide plate rear (5), guide plate upper limb (6) and retainer (7), guide plate leading edge (4) and guide plate rear (5) are respectively guide plate ontology (1)
Left and right ends portion, and cystic lesion prezone instruction edge (8) is equipped at guide plate leading edge (4) end, capsule is equipped at guide plate rear (5) end
Boundary's instruction edge (9) after lesion；Guide plate upper limb (6) is located at guide plate ontology (1) upper end, is equipped with guide plate upper limb line (10) at end, leads
Plate upper limb line (10) form is bonded completely with cystic lesion lower edge (11) needed for preoperative simulation；Retainer (7) is located in guide plate
Side (2) bottom end, is in concave, and form is bonded completely with angle of mandible needed for preoperative simulation (12)；It is also set at the guide plate upper limb
Have guiding groove (13), there are two guiding groove (13) is set, be located at guide plate upper limb line (3) two sides and respectively with guide plate upper limb line (10) even
It connects；Cystic lesion prezone instruction edge (8) is concordant with cystic lesion prezone (14), boundary's instruction edge (9) after the cystic lesion
It is concordant with boundary after cystic lesion (15)；
The guide plate is made by following steps:
(1) CT scan is carried out to patient, obtains the head spiral CT scans of patient；
(2) the DICOM data of spiral CT are imported into three-dimensional software for editing and carries out three-dimensional reconstruction, divide simultaneously mandible reconstruction cystic disease
Become and nervus alverlaris and corresponding nervus alverlaris vascular bundles are described in relevant anatomy, simulation；
(3) three-dimensional measurement cystic lesion bounds and its relationship with important anatomy structure around, obtain precise information；
(4) in mandibular surface rendering cystic lesion and nervus alverlaris projection line, lower alveolus mind is designed according to projection line range
Through protection board boundary, fenestration space in art is reserved, in intercepting lower jaw cheek side cortex bone in bounds, by intercepted bone block
STL data import geomagic studio software carry out data surface processing, take out shell thicken processing after shaped it is virtual under
Alveolar nerve protects guide plate, saves as STL data；
(5) STL data are imported into 3D printer, using PLA poly-lactic acid material, is melt into product (FDM) mode and prints neuroprotection
Guide plate is in kind.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201610331075.7A CN105816219B (en) | 2016-05-18 | 2016-05-18 | The nervus alverlaris protection guide plate controlled is scraped based on mandibular cystic lesion |
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| Application Number | Priority Date | Filing Date | Title |
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| CN201610331075.7A CN105816219B (en) | 2016-05-18 | 2016-05-18 | The nervus alverlaris protection guide plate controlled is scraped based on mandibular cystic lesion |
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| CN105816219A CN105816219A (en) | 2016-08-03 |
| CN105816219B true CN105816219B (en) | 2018-12-21 |
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| CN108066007A (en) * | 2016-11-18 | 2018-05-25 | 深圳市普天阳医疗科技股份有限公司 | A kind of lower jaw fenestration guide plate and production method |
Citations (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN104939951A (en) * | 2014-03-26 | 2015-09-30 | 上海交通大学医学院附属第九人民医院 | Artificial temporal-mandibular joint replacement bone trimming guide plate assembly |
| CN105342708A (en) * | 2015-12-14 | 2016-02-24 | 四川大学 | CT (computerized tomography) and CBCT (cone beam computerized tomography) fusion data based digital occlusion guide plate and reconstruction method thereof |
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| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| FR2801191B1 (en) * | 1999-11-19 | 2002-02-15 | Proconcept | PROTECTION DEVICE FOR NERVES AFTER SURGERY |
| CN201752420U (en) * | 2010-08-05 | 2011-03-02 | 蒋春意 | Novel mandibular angle osteotomy protection board |
| CN104939922A (en) * | 2014-03-26 | 2015-09-30 | 上海交通大学医学院附属第九人民医院 | Nerve protection guide plate for mandible osteotomy |
| CN205814381U (en) * | 2016-05-18 | 2016-12-21 | 四川大学 | The inferior alveolar nerve protection guide plate controlled is scraped based on mandibular bone cystic lesion |
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2016
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Patent Citations (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN104939951A (en) * | 2014-03-26 | 2015-09-30 | 上海交通大学医学院附属第九人民医院 | Artificial temporal-mandibular joint replacement bone trimming guide plate assembly |
| CN105342708A (en) * | 2015-12-14 | 2016-02-24 | 四川大学 | CT (computerized tomography) and CBCT (cone beam computerized tomography) fusion data based digital occlusion guide plate and reconstruction method thereof |
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Inventor after: Ju Rui Inventor after: Tian Weidong Inventor after: Tang Wei Inventor after: Zhou Zhongwei Inventor after: Zeng Wei Inventor after: Li Peng Inventor before: Tang Wei Inventor before: Tian Weidong Inventor before: Ju Rui Inventor before: Zhou Zhongwei Inventor before: Zeng Wei Inventor before: Li Peng |
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