下颌骨定位导板在腓骨瓣游离移植修复下颌骨缺损中定位髁突效果的初步研究  

Mandibular fixation guides for condyle fixation in an accurate mandibular reconstruction with fibular flaps

作　　者：章茜[1] 王怡 王育新[1] Zhang Qian;Wang Yi;Wang Yuxin(Department of Oral and Maxillofacial Surgery,Nanjing Stomatological Hospital,Medical School of Nanjing University,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属口腔医院(南京市口腔医院)口腔颌面外科,南京210008

出　　处：《中华解剖与临床杂志》2020年第3期249-254,共6页Chinese Journal of Anatomy and Clinics

基　　金：江苏省重点研发计划(BE2018618)。

摘　　要：目的评价下颌骨定位导板在腓骨瓣游离移植修复单侧下颌骨缺损中定位髁突位置的作用。方法回顾性分析2017年1月—2018年12月于南京市口腔医院应用下颌骨定位导板进行下颌骨节段性截骨后腓骨游离移植修复的10例患者的临床资料。其中,男7例、女3例,年龄22~65岁。下颌骨成釉细胞瘤4例,下颌骨中央性癌2例,下颌牙龈鳞癌4例;BrownⅠ类缺损7例,BrownⅡ类缺损3例。术前计算机模拟手术方案,3D打印数字化导板,术中应用数字化导板精确重建下颌骨,术后评估并发症的发生情况,利用图像融合技术评估残余下颌骨位置与手术设计中对应位置的偏差情况,并通过锥形束CT对比手术前后双侧颞下颌关节间隙的改变来评估髁突位置变化。结果手术导板在术中均能顺利就位,腓骨瓣均存活,手术时间(482.56±59.83)min。1例患者术后即出现轻度张口受限,张口度2.5 cm,其余患者未出现钛板外露、术创感染、颞下颌关节区疼痛等并发症。所有患者术后面容对称,咬合关系良好。术后图像融合显示术后残余下颌骨位置与术前对应位置相比平均偏差为(-0.69±2.28)mm。锥形束CT结果显示,术后双侧颞下颌关节上间隙、前间隙、后间隙与术前比较差异均无统计学意义(P值均>0.05),髁突位置较术前无明显改变。结论下颌骨定位导板辅助游离腓骨修复下颌骨节段性缺损能有效定位残余下颌骨及髁突位置。Objective This study aimed to evaluate the effect of a mandibular fixation guide for condyle fixation on mandibular reconstruction using fibular flaps.Methods This study included 10 patients(7 males and 3 females,aged 22-65 years),who were treated for mandibular resection and reconstruction using fibular flaps in Nanjing Stomatological Hospital from January 2017 to December 2018.Among the 10 patients,4 were diagnosed with adamantoblastoma,2 were diagnosed with primary intraosseous carcinoma of the mandible,and 4 were diagnosed with carcinoma of the lower gingiva.These patients used guide plates,including mandibular and fibula cutting,mandibular fixation,and titanium plate transfer guides,for the entire procedure.All the patients were followed up and evaluated for postoperative complications,temporomandibular joint(TMJ)space,and residual mandibular position.Results All surgical guides were applied successfully during surgery,and all fibular flaps survived.The duration of surgical operation was approximately(482.56±59.83)min.One patient complained of limited mouth opening by approximately 2.5 cm,but no other complication occurred.The shifted distance of the affected residual mandible was(-0.69±2.28)mm.No significant change was observed in the anterior,upper,and posterior spaces of the TMJ after surgery(all P values>0.05).Conclusions A mandibular fixation guide reduced changes in the TMJ space and the shift of the residual mandible;thus,it benefits mandibular reconstruction using fibular flaps.

关 键 词：下颌损伤 重建外科手术 下颌骨缺损 定位导板 下颌骨修复重建 腓骨 

分 类 号：R782.4[医药卫生—口腔医学]