数字化外科技术在下颌骨缺损修复中的临床应用研究  

Clinical application of digital surgical technique in mandibular defect repair

作　　者：刘福来 李志萍 孟箭 葛良玉 LIU Fu-lai;LI Zhi-ping;MENG Jian;GE Liang-yu(Xuzhou Central Hospial Afiliated to Bengbu Medical College,Xuzhou 221009,China)

机构地区：[1]蚌埠医学院附属徐州市中心医院,江苏徐州221009

出　　处：《中国实用口腔科杂志》2021年第3期333-337,共5页Chinese Journal of Practical Stomatology

基　　金：江苏省卫生健康委科研课题(H2017080);徐州市科技计划项目(KC20088)。

摘　　要：目的评价数字化外科技术在下颌骨缺损修复中的临床应用效果。方法选择2018年7月至2019年6月于徐州市中心医院就诊的下颌骨肿瘤或囊肿患者8例。所有患者术前均进行颌骨三维CT和下肢CT血管造影(CTA)检查。应用Mimics 8.11软件对下颌骨病灶进行截骨范围设计、缺损的镜像重建。应用3D打印技术制作截骨、塑形和复位导板,同时根据镜像重建下颌骨模型预弯钛板。术中根据截骨、塑形和复位导板完成下颌骨的切除、血管化腓骨肌皮瓣的制备及下颌骨缺损的即刻修复。术后评价患者面型、张口度、咬合关系,并结合影像学资料评价骨结合及髁突位置情况。结果所有患者均为Ⅰ期愈合,移植的血管化腓骨肌皮瓣全部成活。患者面型逐渐恢复对称,咬合关系良好,张口度恢复至3.0~3.8 cm;病灶未累及下颌升支及髁突的患者两侧髁突均位于关节窝内,盘髁关系均尚可;腓骨与下颌骨结合良好,无异常骨吸收。结论应用数字化外科技术辅助修复下颌骨缺损的临床效果良好,建议在临床中推广应用。Objective To evaluate the clinical effect of digital surgical technique in mandibular defect repair. Methods From July 2018 to June 2019,8 patients with mandibular tumor or cyst were treated in Xuzhou Central Hospital and they were selected. Preoperative Three dimensional CT of jaw and CT angiography(CTA)of lower limbs were performed in all patients. Computer software(Mimics 8.11)was used to design the osteotomy range of the mandibular lesions and to reconstruct the mirror image of the defects. The osteotomy and plastic guide plate were printed by 3 D printing technology,and the pre-bending titanium plate was reconstructed according to the printed mirror image of the mandible model. Mandibular resection,vascularization of fibular musculocutaneous flap and immediate repair of mandibular defect were performed according to osteotomy and plastic guide plate during the operation. Postoperative facial shape,degree of mouth opening and occlusal relationship of the patients were evaluated,and osteosynthesis and condyle position were evaluated based on the imaging information. Results All patients healed at stage Ⅰ and all the grafted vascularized fibular musculocutaneous flaps survived. The facial shape of the patients gradually recovered to symmetry,the occlusal relationship was good,and the degree of mouth opening was restored to 3.0-3.8 cm. The condyles of the patients without mandibular extension or condyle involved were all located in the fossa,and the discocondyle relationship was acceptable. The fibula combined well with the mandible without abnormal bone resorption. Conclusion Digital surgical technique is effective in repairing mandibular defects and it is recommended to be applied in clinic.

关 键 词：数字化外科技术 3D打印技术 下颌骨重建 

分 类 号：K78[历史地理—历史学]