个体化钛网支架复合游离皮瓣修复上颌骨缺损初步研究  

Restorations of maxillary defects by individualized titanium meshes and microvascular free flaps

作　　者：郑维银[1] 羊书勇[1] 李浩[1] 吴坡[1] 

机构地区：[1]成都军区总医院口腔科,四川成都610017

出　　处：《口腔医学》2016年第2期154-157,共4页Stomatology

摘　　要：目的探讨在3D打印上颌骨模型上预制作钛网支架复合游离皮瓣行上颌骨缺损修复的的临床疗效。方法对我院2年来治疗的18例上颌骨缺损、术中将在术前根据CT数据制作的个体化3D模型上预备的内固定钛网支架植入形成面部支撑、复合游离皮瓣关闭口鼻腔的患者进行回顾分析。结果 18例患者中,应用腹直肌皮瓣4例、前臂皮瓣6例、上臂外侧皮瓣3例、股前外侧皮瓣5例,所有组织瓣均成活良好,术后面部外形对称,口鼻腔及口腔上颌窦封闭完全,均能经口腔进食,术后语音清晰,仅有2例合并有软腭缺损患者术后进流食时偶有轻度鼻腔返流现象。结论个体化3D模型并预制作钛网结合游离组织瓣修复上颌骨缺损在改善患者术后的功能和外形上能取得令人满意的结果,但对游离组织瓣封闭口鼻腔后对义齿修复的影响有待进一步探讨。Objective To evaluate the clinical efficacy of restorations of maxillary defects by mierovascular free flaps and individual titanium meshes based on 3 D printed maxilla models. Methods Retrospective analysis of 18 cases with maxillary defects from 2011 to 2013 was made. For all the cases, 3D models internally fixed with titanium meshes fabricated according to preoperative CT data were implanted to support their faces, and microvascular free flaps were used to close their oral and nasal cavities. Results 4 cases used rectus abdominis muscle flaps, 6 cases forearm flaps, 3 cases lateral arm flaps, and 5 cases anterolateral thigh flaps. All flaps were a- live. Moreover, faces of all cases were symmetric, closure of oral and nasal cavities as well as maxillary sinus was complete so that all cases were able to eat through oral cavities, and their postoperative vocalization was clear. Only 2 cases with soft palate defects occa- sionally suffered from mild nasal regurgitation when having liquid diets. Conclusion Individualized 3D models and titanium meshes combined with mierovascular free flaps used in restoring maxillary defects can obtain satisfactory functional and aesthetic outcomes for patients. However, the effects of closing oral and nasal cavities by free tissue flaps on the restoration of false teeth need to be further explored.

关 键 词：上颌骨 缺损 3D打印 修复重建 

分 类 号：R782.23[医药卫生—口腔医学]