数字化外科技术辅助腓骨肌皮瓣修复上颌骨前部缺损  

Reconstruction of anterior maxilla defect with fibula musculocutaneous flap assisted by digital surgical technology

作　　者：孙国文[1] 杨旭东[1] 文建民[1] 陈欣[1] 胡勤刚[1] Sun Guowen;Yang Xudong;Wen Jianmin;Chen Xin;Hu Qingang(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,210008

出　　处：《中华整形外科杂志》2021年第10期1122-1128,共7页Chinese Journal of Plastic Surgery

摘　　要：目的探讨数字化外科技术辅助腓骨肌皮瓣修复上颌骨前部缺损的临床效果。方法对2014年1月至2020年1月南京市口腔医院收治的采用腓骨肌皮瓣修复的上颌骨前部缺损患者的临床资料进行回顾性分析。先利用患者术前CT数据通过Mimics 23.0软件进行计算机虚拟手术,完成病灶截骨导板、腓骨塑形导板和腓骨复位导板等手术导板及手术方案的设计,并通过Accunavi-A导航系统设计导航配准点,然后3D打印出上述手术导板。术中在手术导板及导航技术辅助下切取腓骨肌皮瓣修复上颌骨前部病灶切除后的缺损。术后对面部外观及功能进行随访。结果共纳入12例患者,男9例,女3例,年龄33~56岁。其中5例上颌前部牙龈癌,4例上颌骨前部成釉细胞瘤,1例上颌软骨肉瘤,1例上颌前部高分化黏液表皮样癌,1例上颌骨前部牙源性黏液瘤。病灶切除后的缺损范围为5 cm×4 cm~6 cm×5 cm。12例患者病灶截骨导板与腓骨塑形导板设计准确,术中腓骨复位导板就位成功,导航精确、无移位,移植的腓骨位置与正常上颌骨位置相符,修复所用腓骨长度为8~10 cm,肌皮瓣大小为5 cm×4 cm~6 cm×5 cm,所有腓骨肌皮瓣均存活。术后随访1~72个月,平均24.5个月,患者发音清晰,进食时无口鼻腔反流现象,面部外形良好。12例患者随访期间肿瘤未复发。结论在数字化外科技术辅助下应用腓骨肌皮瓣修复上颌骨前部缺损是一种较为精确、可行的方法,口鼻腔封闭和语言功能均得到较好的维护,同时也获得了较为满意的面部外形。Objective To investigate the precise reconstruction method of anterior maxillary defect with fibula musculocutaneous flap assisted by digital surgical technology.Methods The clinical data of the patients with anterior maxillary defect repaired by fibular free flap from January 2014 to January 2020 in Nanjing Stomatological Hospital were analyzed retrospectively.Mimics 23.0 software was used to perform computer virtual surgery using preoperative CT data of patients.Then the design of the focal osteotomy guide plate,fibular plastic guide plate and fibular reduction guide plate as well as the surgical plan was completed.The navigation registration point was designed by the Accunavi-A navigation system.The surgical guide plates were 3D printed.During the operation,the fibular musculocutaneous flap was harvested to cover the defect after resection of the anterior maxillary lesion with the assistance of the surgical guide plate and navigation technology.The facial appearance and function were followed up after operation.Results A total of 12 cases,9 males and 3 females,aged from 33 to 56 years,were included.There were 5 cases of gingival carcinoma,4 cases of ameloblastoma,1 case of chondrosarcoma,1 case of mucoepidermoid carcinoma and 1 case of odontogenic myxoma.The size of the defect after resection was 5 cm×4 cm-6 cm×5 cm.In 12 patients,the focal osteotomy guide plate and fibula plastic guide plate were designed accurately,and the fibular reduction guide plate was successfully placed with accurate navigation and no displacement during the operation.The position of transplanted fibula was consistent with the normal maxillary position.The length of fibula was 8-10 cm,and the size of the fibular free flap was 5 cm×4 cm-6 cm×5 cm.All fibular musculocutaneous flaps survived.The patients were followed up for 1 to 72 months,with an average of 24.5 months.The patients had clear pronunciation,no oral and nasal reflux during diets,and presented in good facial appearance.No tumor recurrence occurred in 12 patients during f

关 键 词：计算机辅助设计 成像 三维 打印 三维 外科 口腔 上颌骨 口腔肿瘤 腓骨 肌皮瓣 

分 类 号：R782.4[医药卫生—口腔医学]