口腔医学研究

口腔医学研究 ›› 2019, Vol. 35 ›› Issue (8): 766-771.DOI: 10.13701/j.cnki.kqyxyj.2019.08.011

• 口腔颌面外科学研究 • 上一篇    下一篇

个性化原位塑形导板在血管化髂骨肌瓣修复下颌骨缺损中的应用

鲁婷玮, 刘朝明, 吴添福*, 邵喆, 孙艳芳, 孙志军, 刘冰   

  1. 武汉大学口腔医学院口腔颌面头颈肿瘤外科 湖北 武汉 430079
  • 收稿日期:2019-01-16 出版日期:2019-08-28 发布日期:2019-08-22
  • 通讯作者: 吴添福,E-mail:wutianfu@whu.edu.cn
  • 作者简介:鲁婷玮(1996~ )女,江苏常州人,学士在读,主要从事颌面外科的临床及研究工作。
  • 基金资助:
    武汉市青年科技晨光计划(编号:2017050304010305)

Application of Individualized in-situ Moulding Guide Plate in Mandibular Reconstruction using a Vascularized Iliac Muscle Flap

LU Tingwei, LIU Chaoming, WU Tianfu*, SHAO Zhe, SUN Yanfang, SUN Zhijun, LIU Bin   

  1. Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Wuhan University, Wuhan 430079, China
  • Received:2019-01-16 Online:2019-08-28 Published:2019-08-22

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摘要： 目的:分析使用虚拟手术设计的个性化原位塑形导板行血管化髂骨断蒂前原位塑形的临床效果。方法:选取20例收治的行下颌骨肿瘤切除术并用自体髂骨肌瓣重建下颌骨的患者为研究对象。原位塑形导板为按设计截骨后将两侧下颌骨断端用桥杆连接的导板模型。截取髂骨后,按原位塑形导板调磨好骨块,再离断血管蒂。使用和未使用原位塑形导板的患者各10例,分别归为A组和B组,比较术前术后两侧髁突间、下颌角点间距离及下颌骨颏前点至髁突连线中点距离的偏差。结果: 20例手术均成功。A组平均手术时间明显小于B组(5.24 h VS 7.09 h,P=0.01);A、B两组术后平均住院天数(9.6 d VS 11.2 d,P=0.02)。A组与B组相比:术后髁突间距离的平均偏移为:(1.44±0.99) mm VS (1.92±0.81) mm,(P= 0.44);术后下颌角间距离的平均偏移为:(1.83±0.80) mm VS (2.50±1.50) mm,(P=0.36);下颌骨中点至髁突连线中点的平均偏差为:(0.97±0.40) mm VS (2.67±3.31) mm,(P= 0.29)。结论:在髂骨肌瓣血管蒂离断前应用个性化原位塑形导板,可以提高手术效率和精度,促进患者康复。

关键词: 虚拟手术, 原位塑形, 髂骨移植, 下颌骨重建

Abstract: Objective: To analyze the clinical effect of in-situ moulding of vascularized iliac bone before disconnecting vessel pedicle using individualized in-situ moulding guide plate. Methods: 20 patients with mandibular tumors who underwent tumor resection were selected and repaired with autologous iliac muscle flap. The in-situ moulding guide plate was a guide plate that using a bridge to connect two mandibular ends after osteotomy. After iliac bone extraction, the bone was grinded according to the in-situ moulding guide plate. 10 cases were defined as group A which used in-situ moulding guide plate, and 10 cases defined as group B without guide plate. The deviations between post-operative and preoperative design were compared. Results: All 20 operations were successful. Patients recovered well. The average operation time of group A and group B were 5.24h and 7.09h, respectively (P=0.01). The average hospital days after operation were 9.6d and 11.2d, respectively (P=0.02). The average deviations of condylar distance for group A with group B were (1.44±.99) mm and (1.92±0.81) mm, respectively (P=0.44), the average deviations of mandibular angle distance after operation were (1.83±0.80) mm and (2.50±1.50) mm, respectively (P=0.36), and the average deviations from the midpoint of mandible to the midpoint of condylar connection were (0.97±0.40) mm and (2.67±3.31) mm, respectively (P=0.29). Conclusion: The application of individualized in-situ moulding guide plate can improve the operation efficiency and accuracy and promote recovery.

Key words: virtual surgery, in-situ moulding, iliac bone graft, mandibular reconstruction