个性化导板技术在上颌骨缺损精确重建中的应用  

Application of Patient-specific Guiding Templates in Accurate Maxillary Reconstruction

作　　者：刘朝明 郑越予 吴添福 刘冰 邵喆 LIU Chaoming;ZHENG Yueyu;WU Tianfu;LIU Bing;SHAO Zhe(Department of Stomatology, General Hospital of Jianghan Oilfield, Qianjiang 433121, China;Department of Oral and Maxillofacial Head and Neck Oncology, Hospital of Stomatology, Wuhan University, Wuhan 430079, China)

机构地区：[1]湖北江汉油田总医院口腔科,湖北潜江433121 [2]武汉大学口腔医院口腔颌面头颈肿瘤外科,湖北武汉430079

出　　处：《口腔医学研究》2020年第7期669-673,共5页Journal of Oral Science Research

基　　金：科技部重点研发计划(项目编号:2018YFB1107100);武汉市青年科技晨光计划(项目编号:2017050304010305)。

摘　　要：目的:对于计算机辅助设计的数字化导板用于上颌骨缺损精确重建的病例,分析个性化手术导板在上颌骨重建应用过程中的优、缺点,并对其临床效果进行评价。方法:回顾分析2014年3月~2019年6月期间16例上颌骨缺损重建案例,术前采用数字化外科行手术设计,制作个性化手术导板并采用3D打印,在模型上弯制塑形钛网、钛板,在术中严格按照导板操作,术后利用图像融合技术结合影像学检查评价术后效果。结果:16例血管化游离骨瓣均成功存活,重建效果与术前设计基本一致,术后经随访复诊观察所有病例外形满意,骨愈合良好,咬合关系基本正常,供区未出现严重并发症。结论:采用虚拟手术系统制作的个性化手术导板,可以极大的缩减手术过程中调磨骨块、确定骨段位置的时间,降低手术难度,缩短手术时间和供区的损伤。Objective:To analyze the advantages and disadvantages of digital guiding template for accurate reconstruction of maxillary defects,and to evaluate its clinical effect.Methods:Retrospective analysis was performed from March 2014 to June 2019,including 16 cases of maxillary defect reconstruction.All patients used preoperative virtual surgery plan to design,and make personalized surgical guiding templates by following 3D printing.The pre-bending and shaping of titanium mesh and plate were based on the printed 3D model.All procedures during operation were strict according to the guiding template,and postoperative verification used fusion-images technology to evaluate the postoperative effect.Results:16 cases of vascularized free bone flap survived successfully,and the reconstruction effect was basically consistent with the preoperative design.After follow-up,patients were observed with satisfactory appearance,good bone healing,normal occlusal relationship,and no serious complications in the donor area.Conclusion:The personalized guide plate made by virtual operation system can greatly reduce the time of adjusting and grinding bone mass,the time of determining the position of bone segment,and the time of reducing the difficulty of operation,and shorten the operation time and the injury of donor area.

关 键 词：上颌骨重建 腓骨肌皮瓣 数字化 导板 功能性重建 口腔肿瘤 

分 类 号：R78[医药卫生—口腔医学]