数字化技术辅助颌骨截骨及颌面修复的临床应用  

Use of Digital Guide in Accurate Surgery of Maxilla and Mandible:a Primary Application

作　　者：李威[1] 杨旭东[1] 王志勇[1] 卢晓林[1] 王洋 王育新[1] LI Wei;YANG Xu-dong;WANG Zhi-yong;LU Xiao-lin;WANG Yang;WANG Yu-xin(Department of Oral and Maxillofacial Surgery,Nanjing Stomatological Hospital,Medical School of Nanjing University,Nanjing 210008, Jiangsu Province, China)

机构地区：[1]南京市口腔医院南京大学医学院附属口腔医院口腔颌面外科

出　　处：《口腔颌面外科杂志》2018年第2期75-79,共5页Journal of Oral and Maxillofacial Surgery

基　　金：江苏省南京市社会发展项目(201503037)

摘　　要：目的:将系列数字化导板用于上下颌骨截骨及修复,实现上、下颌骨缺损的个体化精确修复。方法:15例上颌骨次全切除及下颌骨节段性截骨的患者,男性9例,女性6例,均行术前规划,并3D打印数字化导板,术中分别应用即刻赝复体修复上颌骨缺损,同期血管化腓骨瓣移植修复下颌骨缺损。术中使用导航验证截骨范围,术后利用图像融合技术评价术后效果。结果:导板术中就位顺利,截骨范围与术前设计基本一致。即刻赝复体能顺利戴入,重建钛板及髁突位置准确,面型及咬合关系恢复良好。术后图像融合显示,15例上/下颌骨截骨实际手术与虚拟手术平均偏差,平均为(0.43±0.10) mm。结论:数字化系列导板能够在术中准确还原术前设计,减少手术时间;其与手术导航相辅相成,能实现颌骨个体化、精确化的截骨及颌面缺损修复。]Objective: To apply serial digital guide to the osteotomy of maxillary and mandibular lesions and defect reconstruction, realizing accurate and individual reconstruction of maxillary and mandibular defect. Methods: 15 patients underwent subtotal resection of maxilla or segmental osteotomy of mandible, of which 9 were male, 6 were female. Preoperative design was made before by serial digital guides and manufactured using 3D printing. Mandible was reconstructed with the help of serial digital guide while maxilla was recovered with immediate prosthesis. Osteotomy range was verified via navigation. Image fusion technology was used to evaluate postoperative outcome. Results: All guides took position smoothly. Osteotomy range was exactly as designed. Immediate prosthesis fit in properly. Reconstruction titanium plate and condyle were in their position as designed. Ideal occlusion and facial contour were achieved. Postoperative image fusion showed a (0.43±0.10) mm average deviation between pre- and post-operative positions. Conclusion: Serial digital guide could realize preoperative design and reduce operation time, and could work with surgical navigation to be applied in accurate and individual osteotomy of maxillary and mandibular lesion and defect reconstruction.

关 键 词：数字化导板 术中导航 精确截骨 个体化修复 图像融合 

分 类 号：R782[医药卫生—口腔医学]