WO2021077451A1 - 一种用于下颌骨牵张成骨的数字化导板及其制作方法 - Google Patents

一种用于下颌骨牵张成骨的数字化导板及其制作方法 Download PDF

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WO2021077451A1
WO2021077451A1 PCT/CN2019/114116 CN2019114116W WO2021077451A1 WO 2021077451 A1 WO2021077451 A1 WO 2021077451A1 CN 2019114116 W CN2019114116 W CN 2019114116W WO 2021077451 A1 WO2021077451 A1 WO 2021077451A1
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mandible
mandibular
guide plate
model
digital
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PCT/CN2019/114116
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English (en)
French (fr)
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罗恩
杜文
许春炜
刘瑶
白沅艳
纪焕中
赵文丽
何�泽
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四川大学
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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
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/60—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like for external osteosynthesis, e.g. distractors, contractors
    • A61B17/66—Alignment, compression or distraction mechanisms
    • A61B17/663—Alignment, compression or distraction mechanisms for jaw bones, e.g. subcutaneous distractors with external access
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B2017/568—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor produced with shape and dimensions specific for an individual patient

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  • the invention relates to the field of auxiliary medical devices, and more specifically to a digital guide plate for mandibular distraction osteogenesis and a manufacturing method thereof.
  • Distraction osteogenesis as a technique that can effectively increase the bone mass of the patient's mandible, is widely used in the treatment of severe unilateral mandibular underdevelopment and secondary maxillofacial deformities.
  • Distraction osteogenesis refers to the application of mechanical traction to the osteotomy area through osteotomy and procedural procedures to mobilize and activate the body's own ability to resist injury and regeneration to repair bone defects or extend bones. Patients with unilateral mandibular underdevelopment are often accompanied by secondary asymmetry of the jaw.
  • Distraction osteogenesis is often used as a means to increase bone mass in conjunction with second-stage orthognathic surgery and contouring. Therefore, distraction The effect of osteogenesis is very likely to affect the entire treatment plan and the final treatment effect. Distraction osteogenesis requires the use of a special jaw distractor. At present, there are many kinds of finished distractors used in clinical distraction osteogenesis. The commonly used distractors in oral and maxillofacial surgery are mostly built-in linear distractors. The direction of distraction osteogenesis depends on the direction in which the distractor is placed, and different directions of distraction osteogenesis will have a great impact on the final treatment effect. In the past, the simulation of distractor placement in distraction osteogenesis surgery was mostly performed on X-rays.
  • the present invention provides a digital guide plate for mandibular distraction osteogenesis and a manufacturing method thereof.
  • a digital guide plate for mandibular distraction osteogenesis including:
  • the upper source placed at the front end extends forward along the lateral surface of the patient's mandible and crosses the outer oblique line of the mandibular ascending branch to form a first positioning portion of the wrapping structure;
  • the sub-source placed at the front end extends downwards along the lateral surface of the patient's mandible and after approaching the mandibular foramen, it extends from the inner side of the mandible to form a second positioning part of the enveloping structure;
  • the third positioning part is placed at the rear end and extends along the outer and rear edge of the ascending mandibular branch to form a surrounding structure;
  • Guide separation line used to guide the direction of mandibular osteotomy.
  • a method for manufacturing a digital guide plate for mandibular distraction osteogenesis including the following steps:
  • the female mold of the distractor that closely fits the shape is designed
  • the position of the three positioning parts of the affected mandible draw the outline of a guide plate on the outer bone surface of the mandible of the affected side, and generate the first positioning part and the second positioning part of the above guide plate.
  • the positioning part and the third positioning part the inner surface of the guide plate fits with the outer bone surface of the mandible;
  • the present invention has the following advantages and beneficial effects:
  • the digital guide plate of the present invention can realize the accurate design and guidance of distraction osteogenesis, improve the final treatment effect, and reduce the burden on surgical operations and patients as much as possible.
  • this guide can be used for the overall consideration of the plan design for the surgery that originally required two operations, which can avoid unnecessary treatments during the two operations to a certain extent, and may reduce part of the surgical procedures during the second-stage operation. Reduce the patient's physical and economic burden.
  • Figure 1 is a schematic diagram of the structure of the guide plate of the scheme.
  • Figure 2 is the external side view of the guide plate and the mandible.
  • Figure 3 is a bottom view of the guide plate and the mandible.
  • Figure 4 is a physical map of the outside of the guide plate.
  • Figure 5 is a physical view of the inner side of the guide plate.
  • Fig. 6 is a top structural view of the female mold.
  • Figure 7 is a schematic diagram of the cooperation between the female mold and the virtual bending stretcher.
  • Figure 8 is a schematic diagram of the structure of the mandible and the distractor during the operation.
  • a digital guide plate for mandibular distraction osteogenesis includes a first positioning portion 1, a second positioning portion 2, a third positioning portion 3, a positioning hole 4, a guide separation line 5, and a first
  • the positioning portion 1, the second positioning portion 2, and the third positioning portion 3 constitute the main structure of the guide plate.
  • the first positioning part 1 is placed at the front end of the main structure and the upper source extends forward along the outer side of the patient's mandible and crosses the outer oblique line of the mandibular ascending ramus to form an enveloping structure;
  • the second positioning part 2 is placed at the front end of the main structure and the lower source is along the outer side of the patient's mandible Extend face down and near the mandibular foramen, extend from the inner side of the mandible to form an enveloping structure;
  • the third positioning part 3 is placed at the rear end of the main structure and extends along the outer and posterior edge of the ascending mandibular branch to form the inner side of the ascending mandibular branch In the wrapping structure, the three are connected together to form a single body.
  • the positioning hole 4 is used to guide bone drilling and titanium nails to fix the distractor, and can be set on the first positioning part 1, the second positioning part 2, and the third positioning part 3 according to requirements; the guide separation line 5 is used to guide the mandible
  • the direction of osteotomy corresponds to the position of the patient’s osteotomy line.
  • the thickness of the main structure is 2 to 3 mm, that is, the thickness of the first positioning portion, the second positioning portion, and the third positioning portion is 2 to 3 mm.
  • this embodiment discloses a specific manufacturing method of the above guide plate.
  • a method for manufacturing a digital guide plate for mandibular distraction osteogenesis including the following steps:
  • the physical model can be made of plaster.
  • the upper and lower dentition impressions of the patient are obtained with impression materials, and the plaster is used to infuse them.
  • the digital model A can be established by Mimics software from CT data taken when the patient is in the resting position before the operation. After the digital model A is reconstructed, the digital model A is backed up and saved in STL format.
  • E Simulate the cutting of the mandible in the Freeform software.
  • C The osteotomy line of the mandible that needs to be distracted on the osteogenesis side. During the simulation process, try to avoid hurting the inferior alveolar nerve bundle and include the uninvolved mandible.
  • the bones of the bone and mandibular dentition are registered under the maxillary and skull model B according to the terminal occlusal relationship.
  • the mandibular model C and the maxillary and skull model B are taken as a whole, with the contralateral condyle as the axis, according to aesthetics
  • the standard design of the position of the bone block after the operation is to simulate the digital model D of the craniomaxillofacial area after the operation and save it in STL format;
  • F. Use Freeform software to simulate the direction of the guide rod of the mandibular distraction osteogenesis distractor on the surgical side in the cranio-maxillofacial digital model D. This direction is the side where the distraction osteogenesis is required, and the mandibular stump corresponds to both sides Point of the connection.
  • G Import the distractor model used in the operation and place the retractor in the direction of the guide rod, and adjust the position of the distractor by translation to fit the mandible bone surface of the mandible model C to be distracted.
  • the ratio of the distractor model to the distractor during the operation is 1:1.
  • the placement of the distractor needs to be considered: 1Whether the mandibular ends on both sides have enough bone for titanium nail fixation (the mandibular titanium nails on each side should be three or more); 2The fixation position of the titanium nails should be avoided.
  • the distraction device is usually placed by submandibular extraoral approach, and the placement position of the simulated distraction device should be placed as low as possible;
  • the simulated bone resection line can be designed according to the actual surgical needs. It is a straight line, it can also be a broken line or a zigzag shape, and the placement of the distractor should also be adjusted appropriately according to the personalized osteotomy line. Then bend the distractor's fixed piece in the software to further fit the bone surface.
  • the position of the three positioning parts of the affected mandible draw the outline of a guide plate on the outer bone surface of the affected mandible, and generate the guide plate in the embodiment with a thickness of 0.25mm
  • the first positioning part, the second positioning part and the third positioning part, the inner surface of the guide plate is attached to the outer bone surface of the mandible.
  • the guide plate in Example 1 can be made by the above method, which is specially designed for patients with underdeveloped unilateral mandible and secondary asymmetric deformities.
  • the guide plate is assisted by computer software for simulation, which can avoid the design of the guide plate.
  • the important anatomical structure improves the safety of the operation, can greatly save the cost of making models, save the time of operation design, and avoid errors caused by too many intermediate links.
  • the designed guide plate can reduce the surgical error and improve the final surgical effect; and before the operation, the position of the distractor, the position of the nail hole and the direction of the osteotomy line are determined, and they are bent in advance
  • the distractor is made, which saves operation time, improves operation efficiency, and reduces the burden on doctors and patients.
  • the guide plate prepared by the method of this plan takes into account the overall consideration of the plan design for the operations that originally required two operations, which can avoid unnecessary treatments during the two operations to a certain extent, and may reduce some of the operations during the second-stage operation. It reduces the physical and economic burden of patients.

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Abstract

一种用于下颌骨牵张成骨的数字化导板及其制作方法，该数字化导板包括：置于前端上源沿患者下颌骨外侧面向前延伸并越过下颌升支外斜线形成包绕结构的第一定位部(1)；置于前端下源沿患者下颌骨外侧面向下延伸并在靠近下颌骨颏孔以后处，从下向下颌骨内侧延伸形成包绕结构的第二定位部(2)；置于后端沿下颌升支外后缘向下颌升支内侧延伸形成包绕结构的第三定位部(3)；用于引导骨钻孔及钛钉固定牵张器的定位孔洞(4)；用于引导下颌骨截骨方向的引导分离线。该导板可实现对对牵张成骨术的准确设计和引导，提升最终的治疗效果，并尽可能的减少手术操作和患者的负担。

Description

一种用于下颌骨牵张成骨的数字化导板及其制作方法 技术领域
本发明涉及辅助医疗器械领域，更具体的说是涉及一种用于下颌骨牵张成骨的数字化导板及其制作方法。
背景技术
因各种因素导致的单侧下颌骨发育不足及继发的颌面部畸形在口腔颌面外科临床工作中较为常见，且治疗难度较大。牵张成骨术作为一种可以有效增加患者下颌骨骨量的技术，被广泛用于单侧下颌骨严重发育不足及继发颌面部畸形的治疗。牵张成骨术，是指通过截骨及程序性对截骨区施加机械牵引力，调动并激活机体自身抗损伤再生能力，来修复骨缺损或延长骨骼。单侧下颌骨发育不足的患者多伴有继发的颌骨不对称畸形，牵张成骨术常作为增加骨量的手段用来配合二期的正颌外科手术及轮廓修整术，因此牵张成骨的疗效极有可能影响整个治疗方案和最终的治疗效果。牵张成骨术需要使用专门的颌骨牵张器，目前临床用于牵张成骨的牵张器成品有很多种，口腔颌面外科常用的牵张器多为内置型线性牵张器。牵张成骨的方向取决于牵张器安放的方向，不同的牵张成骨方向会对最终治疗效果产生极大影响。以往进行牵张成骨手术牵张器的放置模拟多通过在X线片上进行，近年来随着数字化技术和3D打印技术的发展，有部分医生在计算机中三维模拟牵张器的放置，或者将患者颌骨模型使用3D打印成型，并在其上模拟手术。但这些方式仅能给医生提供参考，最终颌骨牵张器仍需要医生根据经验在术中实际安置。目前尚没有一种针对单侧下颌骨牵张成骨，治疗单侧下颌骨发育不足及继发的颌骨不对称畸形的数字化导板及设计方法的公开报道，现有单侧下颌骨牵张成骨，需要进行两次手术，患者身体和经济负担重。
发明内容
本发明为了解决上述技术问题提供一种用于下颌骨牵张成骨的数字化导板及其制作方法。
本发明通过下述技术方案实现：
一种用于下颌骨牵张成骨的数字化导板，包括：
置于前端上源沿患者下颌骨外侧面向前延伸并越过下颌升支外斜线形成包绕结构的第一定位部；
置于前端下源沿患者下颌骨外侧面向下延伸并在靠近下颌骨颏孔以后处，从下向下颌骨内侧延伸形成包绕结构的第二定位部；
置于后端沿下颌升支外后缘向下颌升支内侧延伸形成包绕结构的第三定位部；
用于引导骨钻孔及钛钉固定牵张器的定位孔洞；
用于引导下颌骨截骨方向的引导分离线。
一种用于下颌骨牵张成骨的数字化导板的制作方法，包括以下步骤：
A、获得上、下牙列的实物模型；
B、确定上、下牙列实物模型手术后需要的相对位置并标记为终末咬合关系，获取患者上、下牙列的数字化模型Y；
C、建立患者颅颌面骨组织的数字化模型A，并标记出下齿槽神经管位置；
D、将数字化模型Y匹配到数字化模型A的上、下牙列位置，获得含有精确上颌牙列的上颌骨及颅骨模型B和含有精确下颌牙列的下颌骨模型C；
E、模拟切断下颌骨模型C中需要牵张成骨侧的下颌骨的截骨线，将含健侧下颌骨及下颌牙列的骨块按终末咬合关系配准到上颌骨及颅骨模型B下方，将下颌骨模型C和上颌骨及颅骨模型B作为一个整体，以健侧髁突为轴，按照手术后骨块移动的位置，模拟出手术后的颅颌面数字化模型D；
F、在颅颌面数字化模型D中模拟出手术侧下颌骨牵张成骨牵张器引导杆的方向；
G、导入手术中使用的牵张器模型并按引导杆的方向摆放牵引器，平移调整牵张器位置使其与下颌骨模型C拟行骨牵张成骨的下颌骨骨面贴合；
H、根据弯制的牵张器形态设计与其形态紧密贴合的牵张器阴模；
I、依据患侧下颌骨三个定位部位置、钉孔位置及模拟截骨线位置，在患侧下颌骨外侧骨面画出一个导板的轮廓，并生成上述导板的第一定位部、第二定位部和第三定位部，导板内侧面与下颌骨外侧骨面贴合；
J、根据牵张器钉孔位置和下颌骨截骨线在导板上增加定位孔洞及引导分离线；
K、打印设计好的导板。
本发明与现有技术相比，具有如下的优点和有益效果：
1、本发明的数字化导板可实现对对牵张成骨术的准确设计和引导，提升最终的治疗效果，并尽可能的减少手术操作和患者的负担。
2、采用该导板可将原本就需要两次进行的手术，进行方案设计的总体考量，可以在一定程度避免两次手术过程中出现的不必要治疗出现，可能减少二期手术时部分术式，减轻患者身体和经济负担。
附图说明
此处所说明的附图用来提供对本发明实施例的进一步理解，构成本申请的一部分，并不构成对本发明实施例的限定。
图1为本方案导板的结构示意图。
图2为本导板与下颌骨的外侧视图。
图3为本导板与下颌骨的仰视图。
图4为本导板的外侧实物图。
图5为本导板的内侧实物图。
图6为阴模的俯视结构图。
图7为本阴模与虚拟弯制牵张器的配合示意图。
图8为手术时下颌骨与牵张器的结构示意图。
具体实施方式
为使本发明的目的、技术方案和优点更加清楚明白，下面结合实施例和附图，对本发明作进一步的详细说明，本发明的示意性实施方式及其说明仅用于解释本发明，并不作为对本发明的限定。
实施例1
如图1所示的一种用于下颌骨牵张成骨的数字化导板，包括第一定位部1、第二定位部2、第三定位部3、定位孔洞4、引导分离线5，第一定位部1、第二定位部2、第三定位部3构成导板的主体结构。第一定位部1置于主体结构前端上源沿患者下颌骨外侧面向前延伸并越过下颌升支外斜线形成包绕结构；第二定位部2置于主体结构前端下源沿患者下颌骨外侧面向下延伸并在靠近下颌骨颏孔以后处，从下向下颌骨内侧延伸形成包绕结构；第三定位部3置于主体结构后端沿下颌升支外后缘向下颌升支内侧延伸形成包绕结构的，三者连接在一起一体成型。定位孔洞4用于引导骨钻孔及钛钉固定牵张器，根据需求可设置在第一定位部1、第二定位部2、第三定位部3上；引导分离线5用于引导下颌骨截骨方向，与患者的截骨线位置对应。
具体的，主体结构的厚度为2至3mm，即第一定位部、第二定位部、第三定位部的厚度为2至3mm。为了提高导板固定的稳定性，置于第一定位部、第二定位部、第三定位部上的定位孔洞每个定位部上至少有3个。
实施例2
基于上述结构，本实施例公开一上述导板的具体制作方法。
一种用于下颌骨牵张成骨的数字化导板的制作方法，包括以下步骤：
A、获得患者的上、下牙列的实物模型，该实物模型可采用石膏制成，用印模材料获取患者上颌、下颌牙列印模，用石膏灌注即可获得。
B、确定上、下牙列实物模型手术后需要的相对位置并标记为终末咬合关系，通过模型激光扫描仪获取患者上、下牙列的数字化模型Y，以STL格式将上、下牙列及终末咬合关系保存下来。
C、建立患者颅颌面骨组织的数字化模型A，并标记出下齿槽神经管位置。该数字化模型A可通过患者术前处于息止位时拍摄的CT数据，通过Mimics软件建立，数字化模型A重建后，将数字化模型A备份以STL格式保存。
D、通过Geomagic软件的对齐功能将数字化模型Y匹配到数字化模型A的上、下牙列位置，并进行配准，获得含有精确上颌牙列的上颌骨及颅骨模型B和含有精确下颌牙列的下颌骨模型C，并将上颌骨及颅骨模型B、下颌骨模型C以STL格式保存。
E、在Freeform软件中模拟切断下颌骨模型C中需要牵张成骨侧的下颌骨的截骨线，模拟过程中截骨线的位置尽量避免伤及下牙槽神经束，将含健侧下颌骨及下颌牙列的骨块按终末咬合关系配准到上颌骨及颅骨模型B下方，将下颌骨模型C和上颌骨及颅骨模型B作为一个整体，以健侧髁突为轴，按照美学标准设计手术后骨块移动的位置，模拟出手术后的颅颌面数字化模型D并以STL格式保存；
F、利用Freeform软件在颅颌面数字化模型D中模拟出手术侧下颌骨牵张成骨牵张器引导杆的方向，该方向为需行牵张成骨术侧，下颌骨断端两侧对应点的连线。
G、导入手术中使用的牵张器模型并按引导杆的方向摆放牵引器，平移调整牵张器位置使其与下颌骨模型C拟行骨牵张成骨的下颌骨骨面贴合。牵张器模型与手术中牵张器的比例为1:1。牵张器的摆放位置需考虑：①两侧下颌骨断端是否有足够的骨量进行钛钉固定(每侧下颌骨钛钉应尽量满足大于等于三颗)；②钛钉固定位置应避开下牙槽神经管及牙根；③牵张器多采用下颌下口外入路进行安置，模拟牵张器安置位置应尽量置于解剖低位；④模拟切骨线可根据实际手术需要进行设计，可为直线形，也可为折线或Z字形，牵张器的放置也应根据个性化截骨线进行适当调整。随后在软件中弯制牵张器的固定片使其与骨面进一步贴合。
H、根据弯制的牵张器形态设计与其形态紧密贴合的牵张器阴模并以STL格式保存，阴模的结构如图6、7所示。
I、依据患侧下颌骨三个定位部位置、钉孔位置及模拟截骨线位置，在患侧下颌骨外侧骨面画出一个导板的轮廓，并生成厚度为0.25mm的实施例中导板的第一定位部、第二定 位部和第三定位部，导板内侧面与下颌骨外侧骨面贴合。
J、根据牵张器钉孔位置和下颌骨截骨线在导板上增加定位孔洞及引导分离线，如图2、3所示，此时，导板结构设计完成，设计完成的导板以STL格式保存；
K、使用三维打印材料，通过三维打印快速成型法将设计出的导板制作成实物，该实物如图4、5所示。
采用上述方法即可制成实施例1中的导板，其专门针对单侧下颌骨发育不足及继发不对称畸形患者情况进行设计，该导板通过计算机软件进行辅助模拟，可以在设计导板时避开重要的解剖结构提高手术的安全性，可大大节约制作模型的成本，节约手术设计时间，避免中间环节过多导致的误差。模拟过程中基于患者的真实病患情况，设计的导板可以减小手术误差，提高最终手术效果；且在术前确定了牵张器安放的位置，钉孔位置和截骨线方向，并提前弯制了牵张器，节约了手术时间，提高了手术效率，减轻了医生和患者的负担。采用本方案方法制备的导板，将原本就需要两次进行的手术，进行方案设计的总体考量，可以在一定程度避免两次手术过程中出现的不必要治疗出现，可能减少二期手术时部分术式，减轻患者身体和经济负担。
采用本方案制作的导板，在手术中的具体应用如下：
(1)术前以阴模为参考，提前弯制术中所用牵张器使其与阴模紧密贴合；
(2)将单侧下颌骨牵张成骨的数字化导板及牵张器进行消毒备用；
(3)全麻下行口患侧下颌下口外入路切口，分层切开至骨面，剥离骨面肌肉、软组织，将导板置下颌骨外侧设计区域，并使前下后三个固位结构同时就位，使导板紧密贴合在下颌骨骨面上，按照导板上定位孔洞位置进行钻孔并使用钛钉固定导板；
(4)使用往复锯依照导板上引导分离线将下颌骨切开，并检查下颌骨是否完全断开；
(5)取下导板，将牵张器放置于预先设计位置，如图8所示，并对应步骤(3)中钻开的定位孔洞使用钛钉固定牵张器。
以上所述的具体实施方式，对本发明的目的、技术方案和有益效果进行了进一步详细说明，所应理解的是，以上所述仅为本发明的具体实施方式而已，并不用于限定本发明的保护范围，凡在本发明的精神和原则之内，所做的任何修改、等同替换、改进等，均应包含在本发明的保护范围之内。

Claims (5)

  1. 一种用于下颌骨牵张成骨的数字化导板，其特征在于，包括：
    置于前端上源沿患者下颌骨外侧面向前延伸并越过下颌升支外斜线形成包绕结构的第一定位部；
    置于前端下源沿患者下颌骨外侧面向下延伸并在靠近下颌骨颏孔以后处，从下向下颌骨内侧延伸形成包绕结构的第二定位部；
    置于后端沿下颌升支外后缘向下颌升支内侧延伸形成包绕结构的第三定位部；
    用于引导骨钻孔及钛钉固定牵张器的定位孔洞；
    用于引导下颌骨截骨方向的引导分离线。
  2. 根据权利要求1所述的一种用于下颌骨牵张成骨的数字化导板，其特征在于，所述第一定位部、第二定位部、第三定位部的厚度为2～3mm。
  3. 根据权利要求1所述的一种用于下颌骨牵张成骨的数字化导板，其特征在于，所述第一定位部、第二定位部、第三定位部的厚度为2.5mm。
  4. 根据权利要求1所述的一种用于下颌骨牵张成骨的数字化导板，其特征在于，所述定位孔洞置于第一定位部、第二定位部、第三定位部上，且每个定位部上的定位孔洞至少有3个。
  5. 一种用于下颌骨牵张成骨的数字化导板的制作方法，其特征在于，包括以下步骤：
    A、获得患者的上、下牙列的实物模型；
    B、确定上、下牙列实物模型手术后需要的相对位置并标记为终末咬合关系，获取患者上、下牙列的数字化模型Y；
    C、建立患者颅颌面骨组织的数字化模型A，并标记出下齿槽神经管位置；
    D、将数字化模型Y匹配到数字化模型A的上、下牙列位置，获得含有精确上颌牙列的上颌骨及颅骨模型B和含有精确下颌牙列的下颌骨模型C；
    E、模拟切断下颌骨模型C中需要牵张成骨侧的下颌骨的截骨线，将含健侧下颌骨及下颌牙列的骨块按终末咬合关系配准到上颌骨及颅骨模型B下方，将下颌骨模型C和上颌骨及颅骨模型B作为一个整体，以健侧髁突为轴，按照手术后骨块移动的位置，模拟出手术后的颅颌面数字化模型D；
    F、在颅颌面数字化模型D中模拟出手术侧下颌骨牵张成骨牵张器引导杆的方向；
    G、导入手术中使用的牵张器模型并按引导杆的方向摆放牵引器，平移调整牵张器位置使其与下颌骨模型C拟行骨牵张成骨的下颌骨骨面贴合；
    H、根据弯制的牵张器形态设计与其形态紧密贴合的牵张器阴模；
    I、依据患侧下颌骨三个定位部位置、钉孔位置及模拟截骨线位置，在患侧下颌骨外侧骨面画出一个导板的轮廓，并生成权利要求1至3任一所述导板的第一定位部、第二定位部和第三定位部，导板内侧面与下颌骨外侧骨面贴合；
    J、根据牵张器钉孔位置和下颌骨截骨线在导板上增加定位孔洞及引导分离线；
    K、打印设计好的导板。
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