咬合引导的颌骨重建精确度分析及功能评价  

Accuracy and function rehabilitation of occlusion guided jaw reconstruction in 60 patients

作　　者：王明一[1] 王慧珊[1] 杨劼[1] 刘剑楠[1] 曲行舟[1] 张陈平[1] WANG Ming-yi, ONG Hui-shan, YANG Jie, LIU Jian-nan, QU Xing-zhou, ZHANG Chen-ping.(Department of Oromaxillofacial Head and Neck Oncology, Shanghai Ninth People＇s Hospital, College of Stomatology, Shanghai Jiao Tong University; Shanghai Key Laboratory of Stomatology ＆ Shanghai Research Institute of Stomatology; National Clinical Research Center of Stomatology. Shanghai 200011, Chin)

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,上海市口腔医学研究所,国家口腔疾病临床研究中心,上海200011

出　　处：《中国口腔颌面外科杂志》2018年第2期162-166,共5页China Journal of Oral and Maxillofacial Surgery

摘　　要：目的:探讨颌骨缺损重建术中移植骨定位的平面优先原则,确保新建的颌骨功能定位与咀嚼功能恢复,为临床治疗提供指导。方法:对60例颌骨缺损患者,通过数字化虚拟手术设计,确定平面的位置并以其作为参考平面,以咬合关系为引导,进行颌骨定位重建,最终完成种植修复。采集术后1个月和6个月时的CT数据,并与术前设计方案进行对比,分析移植骨就位和种植体植入的精确度,测定咬合力分布情况,进行功能评价。结果:术后1个月时,上颌骨移植腓骨和髂骨就位的精确度分别为(90.28±0.29)%和(89.87±0.41)%,下颌骨分别为(82.21±0.32)%和(89.52±0.18)%,上颌和下颌种植体的精确度分别为(91.72±0.21)%和(86.07±0.26)%。术后6个月时,上颌骨移植腓骨和髂骨就位的精确度分别为(89.24±0.20)%和(89.86±0.37)%,下颌骨分别为(75.39±0.25)%和(85.02±0.17)%,上颌和下颌种植体的精确度分别为(90.22±0.27)%和(85.57±0.31)%。单侧颌骨缺损的咬合力分布健侧为(68.14±8.32)%,患侧为(35.22±5.73)%;而双侧缺损的左、右两侧分别为(52.18±1.75)%和(47.82±2.41)%。结论:咬合引导的颌骨重建能够预先确定移植骨的空间位置、种植体的植入位点与方向,最终实现精准的咬合重建,恢复咀嚼功能,是颌骨功能性重建的有力保障。PURPOSE： To investigate the principle of occlusion plane priority during jaw reconstruction for accurate occlusion guided jaw reconstruction and prosthesis restoration, and provide guidance for clinical practice. METHODS：Virtual surgical plans were draw up and the occlusion plane was determined as the reference plane. Jaw reconstruction and implant-retained prostheses were completed with the guidance of occlusion plane. The accuracy of mandibular reconstruction and implant placement was analyzed with CT data preoperatively and 1 month and 6 months postoperatively, the distribution of occlusal force was measured and compared. RESULTS： One month postoperatively, the accuracy of maxillary reconstruction with fibular and iliac bone grafts was（90.28 ±0.29）% and（89.87±0.41）%, respectively;while the accuracy for mandible reconstruction was（82.21±0.32）% and（89.52±0.18）%. The accuracy of implant placement in maxilla and mandible was（91.72±0.21）% and（86.07±0.26）%, respectively. Six months postoperatively, the accuracy of maxillary reconstruction with fibular and iliac bone grafts was（89.24 ±0.20）% and（89.86 ±0.37）%, respectively; while the accuracy for mandible reconstruction was（75.39 ±0.25）% and（ 85.02 ±0.17）%. The accuracy of implant placement in maxilla and mandible was（90.22±0.27）% and（ 85.57±0.31）%, respectively. The occlusal force distribution of unilateral defect was（68.14±8.32）% and（35.22±5.73）% in the unaffected and affected side, respectively, while（52.18 ±1.75）% and（47.82 ±2.41）% in the left and right side for bilateral defects, respectively. CONCLUSIONS： Occlusion guided jaw reconstruction can be predetermined by the space location of bone grafts and the site and direction of implants, and finally achieve accurate occlusion reconstruction and masticatory function, which can be a powerful guarantee for functional reconstruction of the maxilla and mandible.

关 键 词：平面 咬合引导 颌骨重建 牙槽嵴优先 

分 类 号：R782.2[医药卫生—口腔医学]