应用两亚单元塑形血管化髂骨-腹内斜肌瓣行全上颌骨重建  

Two-subunit-osteotomy approach of vascularized iliac-internal oblique muscle composite flap in total maxillary reconstruction

作　　者：于淼[1] 王慧珊[1] 韩婧[1] 胡龙威[1] 刘剑楠[1] 王洋[1] 张陈平[1] 徐立群[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院·口腔医学院口腔颌面-头颈肿瘤科,上海市口腔医学重点实验室,上海200011

出　　处：《中国口腔颌面外科杂志》2016年第5期430-434,共5页China Journal of Oral and Maxillofacial Surgery

基　　金：上海市科学技术委员会技术创新计划(15411950300)

摘　　要：目的 :通过对正常上颌骨形态的测量与分析,明确上颌骨形貌特征和规律,指导移植骨瓣塑形和全上颌骨重建。方法:收集40例华东地区正常成人上颌骨CT数据(Dicom格式),其中男22例、平均年龄23岁;女18例、平均年龄21岁。应用Proplan CMF 2.0软件行上颌骨三维重建,设定上颌骨6个外形标志点、6条线段及2个平面。采用SPSS 19.0软件包对上颌骨外形数据进行t检验或秩和检验,确定上颌骨外形参数(δ)。在此基础上,提出两亚单元塑形法并指导移植骨塑形和全上颌骨重建。结果:上颌骨线性变量的变异系数显著大于角度变量。以鼻根点和上颌第二前磨牙远中牙槽嵴顶连线将上颌骨外形划分为鼻旁区和眶下区2个亚单元。两亚单元前夹角(δ)为150°,无性别差异(P>0.05),总变异系数(CV)为2.74%。临床应用两亚单元法行血管化髂骨-腹内斜肌瓣切开塑形,修复全上颌骨缺损获得满意的外形效果。二期行鼻旁亚单元的种植牙植入,恢复患者的咬合功能。最大牙尖交错位(MIP)状态下,前牙及前磨牙区咬合力恢复至健侧的82%。结论:两亚单元塑形髂骨-腹内斜肌瓣能够准确重建上颌骨外形,封闭口-鼻交通,重塑腭穹窿,为上颌骨功能重建奠定了良好基础。PURPOSE： Through three dimensional measurement and analysis of normal adult maxilla, to delineate maxillary morphological features and regularities which can be applied to conduct osteotomy of iliac bone and reconstruction of total maxillary defect. METHODS： A total of 40 normal maxillary CT data （Dicom format） were collected and delivered to Proplan CMF 2.0. The real-size maxillary model was established on which 6 anatomic bony marks were set up and 7 maxillary contour variables （including 6 linear and 1 angular items） were measured. The data were analyzed using SPSS 19.0 software package. A female patient with total maxillary defect underwent maxillary reconstruction with vascularized iliac composite flap in two-subunit-osteotomy approach was presented. RESULTS： The coeffieienee variation of maxillary linear variables was greater than that of angular variable. The contour of maxilla could be divided into two subunits of paranasal region and infraorbital region though a line segment from nasion to distal alveolar crest of maxillary second premolar. The anterior intersection angle （δ） between the two subunits was 150° with no significant sex and individual differences （P=0.1527, CV=2.74%）. Two-subunit-osteotomy approach was clinically applied to shape the iliac bone into paranasal triangular segment and infraorbital quadrangular segment to reconstruct total maxillary defect, which achieved excellent cosmetic subunit. CONCLUSION： Two-subunit-osteotomy approach of vascularized iliac composite flap can rapidly and accurately reconstruct total maxillary defect and achieve excellent cosmetic and functional results.

关 键 词：全上颌骨重建 髂骨-腹内斜肌瓣 上颌骨外形 

分 类 号：R782.2[医药卫生—口腔医学]