数字化技术辅助设计腓骨瓣修复上颌骨肿瘤切除后缺损  

Digital technology assisted design of fibular flap to repair maxillary defects after resection of maxillary tumor

作　　者：高宁[1] 谢卫红[1] 付坤[1] 刘康彦 蔡菁华[1] 何巍[1] Gao Ning;Xie Weihong;Fu Kun;Liu Kangyan;Cai Jinghua;He Wei(Department of Oral and Maxillofacial Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院口腔颌面外科,郑州450052

出　　处：《中华整形外科杂志》2024年第3期273-277,共5页Chinese Journal of Plastic Surgery

基　　金：河南省科技攻关项目(232102311025,222102310685)。

摘　　要：目的探讨数字化技术辅助设计腓骨瓣修复上颌骨肿瘤切除后缺损并行种植义齿修复的治疗效果。方法回顾性分析2018年3月至2020年10月于郑州大学第一附属医院口腔颌面外科就诊的上颌骨良性肿瘤患者资料。术前采用数字化技术模拟肿瘤切除和腓骨重建,打印模型并制作导板,同时在模型上预成形钛板和手工塑形个性化钛网,术中根据截骨导板切除病变组织,依据手术计划和塑形导板引导腓骨塑形,使用游离腓骨瓣联合个性化预成形钛网重建上颌骨缺损。骨移植后6~9个月置入Straumann种植体,种植后3~4个月进行上部烤瓷冠修复,以恢复咬合关系和咀嚼功能。术后对面部外形、咀嚼功能和种植体周围炎进行随访。结果共纳入12例患者,男7例,女5例,年龄20~55岁,中位年龄36岁。其中骨化纤维瘤3例,成釉细胞瘤7例,牙源性黏液瘤2例。根据James Brown分类法,Ⅱb型4例,Ⅱc型3例,Ⅱd型3例,Ⅲb型2例。12例患者的肿瘤切除和腓骨重建手术过程顺利,游离腓骨瓣全部成活,患者颌面部对称,种植修复后咬合关系良好,咀嚼和吞咽功能恢复正常。种植后随访12~48个月,平均26个月,开口度2.8~3.3 cm,未见明显种植体周围炎。结论采用数字化技术辅助设计腓骨瓣修复上颌骨肿瘤切除后缺损并进行种植义齿修复,不仅能较好地恢复患者的面部外形,而且能重建患者的咬合关系和咀嚼功能。Objective To investigate the therapeutic effect of digital technology assisted design of fibula flap for the repair of maxillary tumor defect and implant denture.Methods A retrospective analysis was performed in patients with benign maxillary tumors who were admitted to Department of Oral and Maxillofacial Surgery,the First Affiliated Hospital of Zhengzhou Universityfrom March 2018 to October 2020.Before the surgery,the virtual tumor resection,fibula reconstruction and stereomodels were printed for the fabrication of fibular osteotomy guide plates.And titanium plates were prefabricated with the stereomodels.Personalized titanium meshes were prebent manually.During the operation,the tumor was removed according to the osteotomy guide plate.The fibula was reshaped according to the surgical plan and the guide plate.And maxillary defects were reconstructed using the fibular flap combined with a prebent personalized titanium mesh.Straumann implants were implanted 6-9 months after bone grafting.The upper porcelain crown was repaired 3-4 months after implantation to restore the occlusal relationship and masticatory function.The facial appearance,masticatory function and peri-implant inflammation were followed up.Results A total of 12 cases were included in this study,7 males and 5 females,aged 20-55 years,with a median age 36 years old.Among them,there were 3 cases of ossifying fibroma,7 cases of ameloblastoma,and 2 cases of odontogenic myxoma.According to the James Brown classification,there were 4 cases of TypeⅡb,3 cases of TypeⅡc,3 cases of TypeⅡd,and 2 cases of TypeⅢb.Tumor resection and fibula reconstruction went smoothly in 12 patients and all the free fibular flaps survived 14 days after surgery.The patients had maxillofacial symmetry,good occlusal relationship after the implant repair,and normal chewing and masticatory functions,after 12-48 months of follow-up,with an average of 26 months.The mouth opening reached 2.8-3.3 cm,without obvious peri-implantitis.Conclusion The use of digital technology to desi

关 键 词：上颌骨 上颌肿瘤 腓骨 牙种植 数字化技术 

分 类 号：R739.8[医药卫生—肿瘤]