臺灣博碩士論文加值系統

下顎骨腫瘤的診斷、病灶去除與口腔功能重建..等手術過程跨越牙科、口腔外科與顏面整形外科..等不同科別，其過程面臨術前、手術中與術後等複雜且冗長的治療問題;傳統顏面腫瘤治療流程需分段進行手術且依賴人工，造成手術次數增加、手術誤差大、醫療成本高、術後顏面外觀不佳..等問題亟待克服。本文目標為整合3D數位化設計、分析與積層製造等技術，應用於下顎骨腫瘤之術前診斷、規劃、設計、手術中切割、定位與術後咬合功能重建之植牙手術，建立診斷、切除與重建手術同步進行之一站式手術的醫學工程技術，以期達成降低病人手術次數、節省成本、提高手術之精度與改善術後顏面外觀之目的。
本文首先建立下顎骨重建之醫學影像數位化與3D模型建構等數位化基礎技術，再者導入先進製造技術-積層製造直接製造醫學模型、手術治具與植入物..等實體模型，應用數位化技術和積層製造技術於下顎骨重建手術、骨膜下植牙手術與客製化矯正器..等醫療病例。數位化資訊與實體模型提供手術前討論的方便性與提高醫生對手術的掌握度、積層製造實體提供手術中切割、定位與植入體，縮短手術時間、提高手術精度與提升手術成功率，達到平行設計與製造之一站式全面服務之先進醫學技術目標。經模擬實驗與臨床手術之實作與驗證結果顯示:數位化技術於手術前診斷與規劃、積層製造技術提供術中所需的治具或植入物，一次到位於手術前提供醫療團隊進行診斷、設計與手術操作之程流程，可以達到一次手術中進行下顎腫瘤診斷、規劃設計、切割去除、骨頭重建、與植牙等複雜的醫療工程，達到一站式下顎骨重建手術的目標，提高醫學技術之水準。

Complete mandible reconstruction surgery includes diagnosis of jaw bone cancer, lesion removal, reconstruction surgery, and dental implant surgery. The treatment is a long process that requires a multidisciplinary team covering dentistry, oral surgery and facial plastic surgery. It is a complicated process, and lengthy discussion is necessary during the preoperative, intraoperative and postoperative stages. Traditional treatment for facial tumors is performed manually, resulting in an increased number of surgeries, a high number of surgical errors, elevated medical costs, and a poor facial appearance due to asymmetry problems. This study aimed to integrate 3D digital engineering, digitalized design, analysis and additive manufacturing (AM) technology to establish a one-stop-solution surgical process that can deal with diagnosis prior to surgery, tumor removal, and reconstruction surgery with implants in one operation in order to reduce the number of clinical visits, lower the surgery cost, increase the surgical precision, and improve the facial appearance after surgery.
First, this study established the basis of digital technology, including medical image digitization and 3D STL model construction, and then introduced an advanced manufacturing technology, AM, to directly manufacture models of the patient’s soft and hard tissues of the tumor area and molds for fixtures and implants for making the final physical products required for surgery. This new technique integrates digitalized design, analysis of digital data, and AM technology to directly generate medical materials for the treatment processes, including mandible reconstruction surgery, dental implant surgery and customized orthotics. The digital model and AM model provide convenient information for pre-operative discussion, and help doctors to master the surgery easily. AM provides tools, fixtures, and implants that can shorten the surgery duration, improve the surgery precision and enhance the surgery success rate.
As the models, tools, fixtures, and implant can be prepared and available prior to surgery, a one-stop-service is possible for mandible reconstruction surgery using this advanced technique. In this study, pre-clinical simulation and practical clinical surgery validated that this technique can successfully be applied for treatment. The processes include the application of digital design and analysis during the pre-operative stage and direct generation of molds of tools for cutting, fixtures and medical implants by AM prior to surgery, which can offer doctors useful materials for diagnostics and design and assist in establishing the operation flow chart in advance. This study established a new method for mandible reconstruction surgery for oral cancer patients, which offers the surgical team a great tool for performing this complicated medical procedure, shortening the diagnosis, design, bone-cutting, and dental implants processes into one surgery.

摘 要 III
Abstract V
Acknowledgments VII
Contents VII
List of tables XII
List of figures XIII
Nomenclature XVII
Chapter
1 Introduction 1
1.1 Preface 1
1.2 The aim of the study 4
1.3 Review of technology 5
1.4 The main contents of research and improvement 11
2 3D digitalization and additive manufacturing technology 13
2.1 3D digitalization systems for medical engineering 14
2.1.1 Hardware 14
2.1.2 Software for digitalization processes in common use 21
2.2 Additive manufacturing technology 23
2.2.1 Introduction of AM marketing 23
2.2.2 Additive manufacturing systems 25
2.2.3 Application of AM 27
2.3 Summary 32
3 One-stop-solution mandible reconstruction employing AM technology 35
3.1 The processes of mandible reconstruction 36
3.1.1 Digitized and parameterized models of the mandible and fibula 37
3.1.2 Pre-surgical planning and shape design 41
3.1.3 Design of the cutting fixture and registered fixture 42
3.1.4 Application of AM for cutting of the entity 44
3.1.5 Verification and assembly 44
3.1.6 All-in-one mandible reconstruction process 45
3.2 Achievement of simulated cases application 47
3.3 Discussion and summary 52
3.3.1 Discussion 52
3.3.2 Summary 57
4 A pre-study of sub-implants employing AM technology 59
4.1 Methods of design and simulation of sub-implants 60
4.1.1 Model digitization 61
4.1.2 Customized design for sub-implants 62
4.1.3 FEM analysis 64
4.1.4 Rapid and customized manufacturing 66
4.1.5 Testing and verification 66
4.2 Results and achievements 67
4.2.1 Internal stress and deformation of the sub-implant 67
4.2.2 Creation and assembly of the sub-implant 69
4.2.3 Static loading test 70
4.3 Discussion and summary 71
4.3.1 Discussion 71
4.3.2 Summary 74
5 A clinical study of customized sub-implants using AM technology 76
5.1 The processes of clinical surgery of sub-implants 77
5.1.1 Case study 77
5.1.2 Reverse engineering for building the 3D model 78
5.1.3 Planning and design pre-surgery 79
5.1.4 Rapid manufacturing of implants and prosthesis 81
5.1.5 Surgery 83
5.1.6 Post-surgery checks 83
5.2 Achievements of clinical application 83
5.3 Discussion 85
5.4 Summary 91
6 The customizing orthodontic using AM technology 92
6.1 The methods of customized orthodontics technology 92
6.2 Results and achievements 100
6.2.1 Creation of metal brackets 100
6.2.2 Bracket measurements 100
6.3 Discussion and summary 103
6.3.1 Discussion 103
6.3.2 Summary 105
7 Conclusions and future work 107
7.1 Conclusions 107
7.2 Future work 109
References 111
Vita 122

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