逆向工程技术在腓骨瓣修复复杂下颌骨缺损中的应用  

A “Reverse” approach for the reconstruction of mandibular defect using fibular flap

作　　者：沈舜尧[1,2] 柳稚旭 姜腾飞[1] 余婧爽 袁灏[1,2] 张雷 史俊[1,2] 王旭东 SHEN Shun-yao;LIU Zhi-xu;JIANG Teng-fei;YU Jing-shuang;YUAN Hao;ZHANG Lei;SHI Jun;WANG Xu-dong(Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine,Shanghai 200011, China;National Clinical Research Center for Oral Diseases,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology,Shanghai 200011, China)

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颅颌面科,上海200011 [2]国家口腔疾病临床医学研究中心,上海市口腔医学重点实验室,上海市口腔医学研究所,上海200011

出　　处：《上海交通大学学报（医学版）》2019年第9期1060-1064,1060,共5页Journal of Shanghai Jiao tong University:Medical Science

基　　金：上海市申康医院发展中心临床创新三年行动计划（16CR3019A）;上海交通大学医学院附属第九人民医院临床研究助推计划（201618006）;上海交通大学医工交叉重点项目（YG2017ZD03）;上海市教育委员会高峰高原学科建设计划（口腔医学）(人才引进-2018);上海市卫生计生委智慧医疗专项研究项目(2018ZHYL0208);上海市科学技术委员会“科技创新行动计划”政府间国际科技合作项目(18410712000),上海市科学技术委员会科研计划项目(15411967400,16441904903)~~

摘　　要：目的·采用逆向工程技术原理,设计制作截骨导板应用于腓骨瓣修复下颌骨缺损。方法·选取5例复杂下颌骨缺损患者作为研究对象,在其三维打印的下颌骨重建模型上预先弯制重建钛板,通过CT扫描重建下颌骨、钛板、钛钉的三维图像,采用面–面配准的技术逆向回原始下颌骨及腓骨表面,制作带有重建钛板钉孔空间位置的截骨导板。在术中,通过截骨导板截骨并确定重建钛板固定位置,完成多节段腓骨瓣的精确拼接。结果·5例患者均获得满意的临床疗效;术前设计与实际手术的截骨误差可以满足临床应用,其中最大误差为(3.53±2.33)mm,角度误差为3.31.±1.48.。结论·采用逆向工程技术原理设计的腓骨瓣截骨导板可以满足临床使用的要求,临床疗效满意。Objective · To design osteotomy templates for the construction of mandibular defect by using fibular flap in a reverse engineering technique approach. Methods · Five patients with mandibular defect were enrolled and their treatments were designed in a three-dimensional (3D) virtual planning software package. The 3D printing model with shaped reconstruction plate and titanium-screws were under CT scanning and the image was reconstructed and registered back to the original mandible and fibula in a surface-best-fit method. Then the osteotomy template with screw holes of shaped reconstruction plate was designed and fabricated. The reconstruction of mandible with multiple fibular segments was guided by the osteotomy template. Results · All the five patients were discharged successfully with satisfied outcome. The deviation between virtual plan and actual results were calculated: max deviation( 3.53±2.33) mm and the angle deviation 3.31°±1.48°. Conclusion · The accuracy of the osteotomy template is satisfied and can be applied to the clinical use.

关 键 词：逆向工程技术 游离腓骨瓣 下颌骨缺损 虚拟设计 

分 类 号：Q78[生物学—分子生物学]