个性化导板配合实时导航在腓骨肌瓣修复下颌骨缺损中的应用  

Application of personalized guide plate combined with real-time navigation in repairing mandibular defect using fibula muscle flap

作　　者：高廷益[1] 王栋 陈默 展昭均 彭笑 张凯[1] GAO Tingyi;WANG Dong;CHEN Mo;ZHAN Zhaojun;PENG Xiao;ZHANG Kai(Department of Oral and Maxillofacial Surgery,the First Affiliated Hospital of Bengbu Medical College,Bengbu Anhui,233004,P.R.China)

机构地区：[1]蚌埠医学院第一附属医院口腔颌面外科,安徽蚌埠233004

出　　处：《中国修复重建外科杂志》2022年第6期691-697,共7页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：安徽省高校自然科学研究项目(KJ2018A1005);蚌埠医学院自然科学重点项目(2020byzd119);蚌埠医学院科技发展基金项目(BYKY1794)。

摘　　要：目的 探讨个性化导板配合术中实时导航在腓骨肌瓣修复下颌骨缺损中的应用,以期实现下颌骨精准化修复重建。方法 2019年7月—2021年12月收治12例下颌骨肿瘤患者,男9例,女3例;年龄23~71岁,平均55.5岁。原发疾病:成釉细胞瘤2例,鳞状细胞癌6例,骨肉瘤2例,腺样囊性癌1例,鳞状上皮原位癌1例。对患者行下颌骨截断性切除,均采用腓骨肌瓣双叠三段式修复,术前虚拟设计手术方案及导板,术中采用个性化导板配合实时导航进行腓骨截骨和塑形。术后2~3周行薄层CT检查,并与术前虚拟设计方案进行拟合,测量双侧下颌角在三维方向(左右向、垂直向、前后向)上相对基准平面距离的差值,以及腓骨重建下颌骨下缘内侧角度的差值,并计算色谱拟合度平均误差。结果 术中导板及导航应用顺利,腓骨塑形及就位准确。术后腓骨肌瓣均成活,切口愈合良好,咬合关系良好。12例患者均获随访,随访时间1~29个月,平均17个月。术后2~3周测量的双侧下颌角在左右向、垂直向、前后向上相对基准平面距离的差值分别为(–0.24±1.35)、–0.85(–1.35,1.40)和(–0.46±0.78)mm,差异均无统计学意义(t=–0.618,P=0.549;Z=–0.079,P=0.937;t=–2.036,P=0.067);双侧腓骨重建下颌骨下缘内侧角度的差值为(–1.35±4.34)°,差异亦无统计学意义(t=–1.081,P=0.303)。术后CT和术前虚拟设计拟合验证两侧下颌角变化差异不显著,色谱拟合度平均误差为(0.47±1.39)mm。结论 个性化导板配合术中实时导航提高了腓骨肌瓣重建下颌骨的精准度,降低了并发症发生率,为可视化术中导航在腓骨肌瓣重建下颌骨的应用奠定了基础。Objective To explore the application of personalized guide plate combined with intraoperative realtime navigation in repairing of mandibular defect using fibula muscle flap,providing the basis for the precise repair and reconstruction of mandible.Methods The clinical data of 12 patients(9 males and 3 females) aged from 23 to 71 years(mean,55.5 years) between July 2019 and December 2021 were recorded.These patients were diagnosed as benign or malignant mandibular tumors,including 2 cases of ameloblastoma,6 cases of squamous cell carcinoma,2 cases of osteosarcoma,1 case of adenoid cystic carcinoma,and 1 case of squamous carcinoma.All patients were treated with mandibular amputation,and then repaired by double-stacked three-segment fibula muscle flap.Preoperative virtual design scheme and guide plate were performed.During the operation,personalized guide plate combined with real-time navigation was used for fibular osteotomy and shaping.Thin-slice CT examination was performed at 2-3 weeks after operation,and was fitted with the preoperative virtual design scheme.The difference between the distance of bilateral mandibular angles relative to the reference plane in three-dimensional directions(left-right,vertical,and anterior-posterior) and the difference of the medial angle of the lower edge of the mandible reconstructed by fibula were measured,and the mean error of chromatographic fitting degree was calculated.Results The guide plate and navigation were applied well,and the fibula shaping and positioning were accurate.The fibula muscle flap survived,the incision healed well,and the occlusal relationship was good.All 12 patients were followed up 1-29 months,with an average of 17 months.There was no significant difference on the distance of bilateral mandibular angles relative to the reference plane in the left-right[(-0.24±1.35) mm;t=-0.618,P=0.549],vertical [-0.85(-1.35,1.40) mm;Z=-0.079,P=0.937],and anterior-posterior[(-0.46±0.78) mm;t=-2.036,P=0.067] directions.The difference of the medial angle of the lower edge

关 键 词：下颌骨缺损 腓骨肌瓣 实时导航 个性化导板 

分 类 号：R782.4[医药卫生—口腔医学]