Positioning structure and method for bone reconstruction by osteotomy
Technical Field
The invention relates to the technical field of medical appliances, in particular to a positioning structure and method for bone cutting and reconstruction.
Background
The CT of the patient is used for digital design before operation, and proper osteotomy and reconstruction form are determined in advance, so that the method is the best means for improving the excision and repair effects of the maxillofacial tumor at present.
In the prior art, the 3D printed guide plate can transfer a preset scheme in the computer to the real world, and the process is realized by accurately positioning an osteotomy line through the osteotomy guide plate and indicating a reconstruction position through the positioning guide plate. Dentition positioning or support type guides can be used to determine the preset location by unique hard tissue topography (teeth), and the use of dentition morphology positioning adjacent to the defect area is a common application.
However, in the above-described manner, for a patient with missing mandibular dentition or a patient with loosening of peripheral teeth due to a large tumor, an accurate position cannot be determined by the mandibular teeth adjacent to the defective area. In addition, patients with large tumors often have fractures, malocclusions, etc. prior to surgery, and lack reliable occlusion. Therefore, there is a need for a structure for positioning a mandibular osteotomy position and reconstructing the bone position based on the maxillary dentition, regardless of the mandibular teeth.
Disclosure of Invention
The invention aims to provide a positioning structure and a positioning method for reconstructing bones of an osteotomy, which are used for positioning mandibular osteotomy positions and reconstructed bone positions based on maxillary dentition and can be applied to patients with loose teeth or mandibular dentition deficiency caused by various reasons.
To achieve the above object, in a first aspect, the present invention provides a positioning structure for bone reconstruction by osteotomy, comprising a positioning assembly;
the positioning component comprises a maxillary positioning guide plate, a mandibular osteotomy guide plate and a reconstructed bone positioning guide plate; the upper jaw positioning guide plate is provided with an upper jaw occlusal surface, an upper n-shaped splicing and inserting mechanism, a plurality of positioning holes and a plurality of fixing holes; the mandibular osteotomy guide plate is provided with a lower n-shaped splicing and inserting mechanism, a connecting area, a mandibular lower edge indicating area and an osteotomy guide surface; the reconstructed bone in-place guide plate comprises an indication guide plate and a plurality of c-shaped connecting rods; the c-shaped connecting rods are fixedly connected with the indication guide plate respectively and are positioned on one side of the indication guide plate respectively.
Wherein, the thickness of the upper jaw positioning guide plate is 3-4mm.
Wherein the number of the positioning holes is 3-4.
Wherein, the depth of locating hole is 2mm, and the diameter is 3mm.
Wherein the number of the fixing holes is 6-8.
Wherein the diameter of the fixing hole is 1mm.
Wherein the thickness of the mandibular osteotomy guide plate is 3-4mm.
Wherein the number of the c-shaped connecting rods is 3-4.
Wherein the diameter of the c-shaped connecting rod is 3mm.
In a second aspect, the present invention also provides a positioning method for bone reconstruction by osteotomy, which specifically comprises the following steps:
Fixing the dental arch splint and a plurality of fixing holes of the upper jaw positioning guide plate by using steel wires to finish the fixation of the upper jaw positioning guide plate;
Inserting a lower n-shaped splicing and inserting mechanism of a lower jaw osteotomy guide plate into an upper n-shaped splicing and inserting mechanism of an upper jaw positioning guide plate, keeping the lower edge of the lower jaw consistent with a lower jaw lower edge indication area of the lower jaw osteotomy guide plate after stabilizing, and performing osteotomy according to an osteotomy guide surface indication direction;
Removing the mandibular osteotomy guide plate, inserting a plurality of c-shaped connecting rods of the reconstructed bone in-situ guide plate into a plurality of positioning holes of the maxillary positioning guide plate in an aligned manner, tightly aligning the upper edge of the reconstructed bone segment with the indication guide plate, aligning the lower edge of the reconstructed bone with the lower edge of the rest mandible, and fixing by using a titanium plate.
Compared with the prior art, the invention has the following beneficial effects:
1. The enlargement indication: mandible lacks unique morphology due to its smooth surface, and surrounding dentitions are often required to determine the guide plate position during osteotomies. And the patient with huge tumor, loose adjacent teeth and missing mandibular dentition can not use the guide plate through mandibular teeth positioning. The invention uses the upper jaw dentition matched guide plate splicing and inserting mechanism to accurately position the mandible osteotomy position, and compared with the existing various mandible guide plate osteotomy technologies, the invention can be applied to patients with loose teeth or missing mandible dentition caused by various reasons.
2. The steps are simple and easy to popularize and use: the invention only comprises the upper jaw positioning guide plate, the lower jaw bone cutting guide plate and the reconstruction bone positioning guide plate, after the upper jaw positioning guide plate is fixed, all key steps of operation can be guided through the splicing and inserting cooperation of the lower jaw 2 guide plates (the lower jaw bone cutting guide plate and the reconstruction bone positioning guide plate), repeated disassembly and adjustment are not needed, and accurate positioning and inter-jaw distance are kept so as to be beneficial to subsequent planting and repairing.
Drawings
In order to more clearly illustrate the embodiments of the present application or the technical solutions in the prior art, the drawings used in the description of the embodiments or the prior art will be briefly described below.
Fig. 1 is a schematic view of a maxillary positioning guide of a positioning structure for osteotomy reconstruction according to the present invention.
Fig. 2 is a schematic view of a mandibular osteotomy guide plate of a positioning structure for osteotomy reconstruction of the present invention.
FIG. 3 is a schematic view of a guide plate for positioning a reconstructed bone of an osteotomy according to the present invention.
Fig. 4 is a schematic view of the structure of the positioning structure of the reconstructed osteotomy of the present invention when the maxillary positioning guide is docked with the mandibular osteotomy guide.
Fig. 5 is a schematic view of the structure of the positioning structure of the reconstructed bone of the present invention when the maxillary positioning guide of the positioning structure of the reconstructed bone is abutted with the positioning guide of the reconstructed bone.
Fig. 6 is a flow chart of a method of locating an osteotomy reconstruction bone in accordance with the present invention.
The device comprises a 101-upper jaw positioning guide plate, a 102-lower jaw cutting guide plate, a 103-reconstruction bone positioning guide plate, a 104-upper jaw occlusal surface, a 105-upper n-shaped splicing and inserting mechanism, a 106-positioning hole, a 107-fixing hole, a 108-lower n-shaped splicing and inserting mechanism, a 109-connecting area, a 110-lower jaw lower edge indicating area, a 111-cutting guide surface, a 112-indicating guide plate and a 113-c-shaped connecting rod.
Detailed Description
Referring to fig. 1-5, fig. 1 is a schematic structural view of a maxillary positioning guide of a positioning structure for bone reconstruction according to the present invention. Fig. 2 is a schematic view of a mandibular osteotomy guide plate of a positioning structure for osteotomy reconstruction of the present invention. FIG. 3 is a schematic view of a guide plate for positioning a reconstructed bone of an osteotomy according to the present invention. Fig. 4 is a schematic view of the structure of the positioning structure of the reconstructed osteotomy of the present invention when the maxillary positioning guide is docked with the mandibular osteotomy guide. Fig. 5 is a schematic view of the structure of the positioning structure of the reconstructed bone of the present invention when the maxillary positioning guide of the positioning structure of the reconstructed bone is abutted with the positioning guide of the reconstructed bone.
In a first aspect, the present invention provides a positioning structure for osteotomy reconstruction bone: comprises a positioning component; the positioning assembly comprises a maxillary positioning guide 101, a mandibular osteotomy guide 102 and a reconstruction bone seating guide 103; the upper jaw positioning guide plate 101 is provided with an upper jaw occlusal surface 104, an upper n-shaped splicing and inserting mechanism 105, a plurality of positioning holes 106 and a plurality of fixing holes 107; the mandibular osteotomy guide 102 has a lower n-shaped jigsaw mechanism 108, a connection region 109, a mandibular lower edge indicator region 110, and an osteotomy guide surface 111; the reconstructed bone in-place guide 103 includes an indicator guide 112 and a plurality of c-shaped connecting rods 113; the mandibular osteotomy position and the reconstructed bone position are positioned based on the maxillary dentition by the above scheme, and can be applied to patients with loose teeth or missing mandibular dentition caused by various reasons.
For the present embodiment, the upper jaw positioning guide 101 has an upper jaw occlusal surface 104, an upper n-shaped jigsaw mechanism 105, a plurality of positioning holes 106 and a plurality of fixing holes 107; the mandibular osteotomy guide 102 has a lower n-shaped jigsaw mechanism 108, a connection region 109, a mandibular lower edge indicator region 110, and an osteotomy guide surface 111; the reconstructed bone in-place guide 103 includes an indicator guide 112 and a plurality of c-shaped connecting rods 113; the c-shaped connecting rods 113 are fixedly connected with the indication guide plate 112 respectively and are located at one side of the indication guide plate 112 respectively. The upper jaw occlusal surface 104 corresponds to the upper jaw dentition occlusion form, and an upper n-shaped splicing and inserting mechanism 105 is added to the cheek side of the corresponding lower jaw osteotomy line; the lower n-shaped splicing and inserting mechanism 108 is corresponding to the upper n-shaped splicing and inserting mechanism 105 in structure form, and can be fixedly inserted, the connecting area 109 extends from the lower n-shaped splicing and inserting mechanism 108 to the surface of the mandible and clings to the bone surface, and downwards extends to the mandibular lower edge indicating area 110, the near-far middle length of the mandibular lower edge indicating area 110 is at least more than 3cm, and the projection height of the osteotomy guiding surface 111 of the mandibular osteotomy guiding plate 102 at the near-middle side is 2-3mm to indicate the osteotomy surface direction; when in use, the dental arch splint is fixed with the plurality of fixing holes 107 of the upper jaw positioning guide plate 101 by using steel wires, so as to finish the fixation of the upper jaw positioning guide plate 101; inserting the lower n-shaped splicing and inserting mechanism 108 of the mandibular osteotomy guide plate 102 into the upper n-shaped splicing and inserting mechanism 105 of the maxillary positioning guide plate 101, keeping the mandibular lower edge consistent with the mandibular lower edge indication area 110 of the mandibular osteotomy guide plate 102 after stabilizing, and performing osteotomy according to the indication direction of the osteotomy guide surface 111; removing the mandibular osteotomy guide plate 102, inserting the c-shaped connecting rods 113 of the reconstructed bone positioning guide plate 103 into the positioning holes 106 of the maxillary positioning guide plate 101 in alignment, aligning the upper edge of the reconstructed bone segment with the indication guide plate 112 in a clinging manner, aligning the lower edge of the reconstructed bone with the lower edge of the rest mandible, and fixing the reconstructed bone with a titanium plate; by adopting the mode, the mandibular osteotomy position and the reconstructed bone position are positioned based on the maxillary dentition, and the mandibular osteotomy position positioning method can be applied to patients with loose teeth or missing mandibular dentition caused by various reasons.
Wherein, the thickness of the upper jaw positioning guide plate 101 is 3-4mm.
Wherein, the number of the positioning holes 106 is 3-4. The locating holes 106 are evenly distributed on the cheek side.
Wherein, the depth of the locating hole 106 is 2mm, and the diameter is 3mm.
Wherein the number of the fixing holes 107 is 6-8. The fixing holes 107 are uniformly distributed on the edge of the maxillary occlusal surface 104.
Wherein, the diameter of the fixing hole 107 is 1mm. The fixing hole 107 penetrates the upper jaw positioning guide 101.
Wherein, the thickness of the mandibular osteotomy guide plate 102 is 3-4mm.
Wherein the number of the c-shaped connecting rods 113 is 3-4.
Wherein the diameter of the c-shaped connecting rod 113 is 3mm.
The invention relates to a positioning structure for bone reconstruction by bone cutting, which is characterized in that CT, maxillary dentition mouth scan of a patient is collected during design, and the scan is matched with an operation file according to the computer design; when designing the upper jaw positioning guide plate 101: the upper jaw occlusal surface 104 is determined according to the upper jaw dentition occlusal surface, 3-4 locating holes 106 are formed in the cheek side surface of the upper jaw locating guide plate 101 and used for connecting the reconstructed bone locating guide plate 103, 6-8 fixing holes 107 are formed in the edge of the upper jaw occlusal surface 104 and used for a wire ligature dental arch splint, 1 upper n-shaped structure is designed in the upper jaw locating guide plate 101 corresponding to an osteotomy region and used for splicing and fixing the lower jaw osteotomy guide plate 102; when designing the mandibular osteotomy guide plate 102: designing an osteotomy region according to an osteotomy line, wherein the lower edge of the mandibular osteotomy guide plate 102 is flush with the lower edge of the mandible and upwards reaches the maxillary occlusal surface 104, and the upper edge of the osteotomy region of the mandibular osteotomy guide plate 102 is designed with 1 lower n-shaped structure for splicing and fixing with the maxillary positioning guide plate 101; designing the reconstructed bone in-place guide plate 103: the reconstructed bone in-place guide plate 103 is provided with 3-4 c-shaped connecting rods 113 which are matched with the positioning holes 106 inserted into the cheek sides of the maxillary positioning jaw plate, and the indicating guide plate 112 is used for maintaining the interjaw distance and indicating the reconstruction direction.
The positioning structure for bone reconstruction by bone cutting has the advantages that:
1. The enlargement indication: mandible lacks unique morphology due to its smooth surface, and surrounding dentitions are often required to determine the guide plate position during osteotomies. And the patient with huge tumor, loose adjacent teeth and missing mandibular dentition can not use the guide plate through mandibular teeth positioning. The invention uses the upper jaw dentition matched guide plate splicing structure to accurately position the mandible osteotomy position, and compared with the existing various mandible guide plate osteotomy technologies, the invention can be applied to patients with loose teeth or missing mandible dentition caused by various reasons.
2 Steps are simple and easy to popularize and use: the invention only comprises the upper jaw positioning guide plate 101, the lower jaw osteotomy guide plate 102 and the reconstruction bone positioning guide plate 103, after the upper jaw positioning guide plate 101 is fixed, all key steps of operation can be guided through the splicing and inserting cooperation of the lower jaw osteotomy guide plate 102 and the reconstruction bone positioning guide plate 103, repeated disassembly and adjustment are not needed, and accurate positioning and inter-jaw distance are kept so as to be beneficial to subsequent planting and repairing.
Referring to fig. 6, fig. 6 is a flowchart of a method for positioning an osteotomy reconstruction bone according to the present invention.
In a second aspect, the present invention also provides a positioning method for bone reconstruction by osteotomy, which specifically comprises the following steps:
s1, fixing a dental arch splint and a plurality of fixing holes 107 of the upper jaw positioning guide plate 101 by using steel wires, and finishing the fixation of the upper jaw positioning guide plate 101;
s2, inserting a lower n-shaped splicing and inserting mechanism 108 of the lower jaw osteotomy guide plate 102 into an upper n-shaped splicing and inserting mechanism 105 of the upper jaw positioning guide plate 101, keeping the lower jaw edge consistent with a lower jaw edge indication area 110 of the lower jaw osteotomy guide plate 102 after stabilizing, and performing osteotomy according to the indication direction of an osteotomy guide surface 111;
S3, removing the mandibular osteotomy guide plate 102, inserting a plurality of c-shaped connecting rods 113 of the reconstructed bone in-situ guide plate 103 into a plurality of positioning holes 106 of the maxillary positioning guide plate 101 in an aligned manner, tightly aligning the upper edge of the reconstructed bone segment with the indication guide plate 112, aligning the lower edge of the reconstructed bone with the lower edge of the rest mandible, and fixing the reconstructed bone with a titanium plate.
The foregoing disclosure is only illustrative of one or more preferred embodiments of the present application, and it is not intended to limit the scope of the claims hereof, as persons of ordinary skill in the art will understand that all or part of the processes for practicing the embodiments described herein may be practiced with equivalent variations in the claims, which are within the scope of the application.