数字化技术辅助旋髂深动脉穿支嵌合瓣在下颌骨复合组织缺损重建中的临床应用  

Digital assisted chimeric deep circumflex iliac artery perforator flap in the reconstruction of mandibular composite defects

作　　者：展昭均 廖圣恺[1] 陈永锋[1] 高廷益[1] 都晓英[2] 刘亮[1] 杨东昆[1] 余松涛[3] Zhan Zhaojun;Liao Shengkai;Chen Yongfeng;Gao Tingyi;Du Xiaoying;Liu Liang;Yang Dongkun;Yu Songtao(Department of Stomatology,First Affiliated Hospital of Bengbu Medical College,Bengbu,Anhui Province 233004,China;Department of Ultrasound,First Affiliated Hospital of Bengbu Medical College,Bengbu,Anhui Province 233004,China;Department of Radiology,First Affiliated Hospital of Bengbu Medical College,Bengbu,Anhui Province 233004,China)

机构地区：[1]蚌埠医学院第一附属医院口腔科,安徽蚌埠233004 [2]蚌埠医学院第一附属医院超声科,安徽蚌埠233004 [3]蚌埠医学院第一附属医院放射科,安徽蚌埠233004

出　　处：《中华显微外科杂志》2019年第5期429-433,共5页Chinese Journal of Microsurgery

基　　金：安徽高校自然科学重点研究项目(KJ2018A1005)。

摘　　要：目的探讨应用数字化技术辅助旋髂深动脉穿支嵌合瓣(DCIAPF)在下颌骨复合组织缺损修复重建中的临床应用效果。方法从2018年1月至2019年1月,对6例肿瘤术后下颌骨半侧以内缺损的患者,术前利用CTA行旋髂深动脉血管评估,应用数字化软件及3D打印技术模拟血管化髂骨瓣切取,设计制作截骨导板,并模拟重建修复后效果;缺损的下颌骨行DCIAPF的修复,供区直接美容缝合。术后门诊随访3~6个月,评价患者面部外形、颌骨高度、咬合功能和供区并发症情况。结果术后病理检测结果示:成釉细胞瘤2例,牙龈癌4例。切取髂骨长度为6.0~13.0 cm,携带皮瓣面积为3.0 cm×1.0 cm^6.0 cm×5.0 cm。6例旋髂深动脉穿支皮瓣以及髂骨瓣均成活,供、受区切口一期愈合。术后随访3~6个月,患者面部外形、下颌骨高度及咬合功能的恢复均满意,供区均未见明显并发症。结论DCIAPF血供丰富,骨量充足,有足够骨高度,终末皮穿支较恒定,且供区并发症少;结合数字化技术可实现下颌骨缺损的精准修复和创面的立体修复,为行种植牙修复提供了有利的条件,是下颌骨缺损修复重建的理想方法之一。Objective To evaluate the clinical effect of digital assisted chimeric deep circumflex iliac artery perforator flap(DCIAPF)in the reconstruction of mandibular composite defects.Methods From January,2018 to January,2019,6 cases of mandibular tumor patients with postoperative defect within side were treated.Preoperative CTA was used to evaluate the deep branches of spin iliac artery.Digital simulation software and 3D printing technology was taken,vascularized iliac flap of the design guide of bone was made,and the rebuilding effect was simulated.DCIAPF was used to repair the defect of lower jawbone.The donor sites were sutured directly.The patients were followed-up in outpatient department for 3-6 months to evaluate the recovery of the patient's shape,jaw height and occlusal function,as well as the complications in the donor area.Results Postoperation pathological examination results:ameloblastoma in 2 cases,4 cases of gingival cancer.The length of cut out ilium was 6.0-13.0 cm,carrying the flap area of 3.0 cm×1.0 cm-6.0 cm×5.0 cm.Six cases of DCIAPF and iliac bone flap survived.The shape,mandibular height and occlusal function were satisfactory.And no obvious complications were found in the donor area.Conclusion The blood supply of DCIAPF is rich with enough bone mass and height.The position of terminal skin perforators is invariant.The complications of donor sites is less.With the help of digital technology,the accuracy of mandibular defect repair and the 3-dimensional wound repair can be realized,and provides an advantage condition for subsequent dental implant.It is one of the ideal method of reconstruction of mandibular defect.

关 键 词：旋髂深动脉 嵌合皮瓣 穿支皮瓣 数字化技术 下颌骨缺损 重建 

分 类 号：R78[医药卫生—口腔医学]