口腔医学研究

口腔医学研究 ›› 2024, Vol. 40 ›› Issue (1): 23-28.DOI: 10.13701/j.cnki.kqyxyj.2024.01.005

• 口腔颌面外科学研究 • 上一篇    下一篇

口内血管吻合髂骨瓣修复颌骨缺损的临床应用

卜琳琳1,2, 张宏羽1, 曹磊鸣1, 刘冰1,2, 贾俊1,2*   

  1. 1.口颌系统重建与再生全国重点实验室,口腔生物医学教育部重点实验室,口腔医学湖北省重点实验室,武汉大学口腔医(学)院 湖北 武汉 430079;
    2.武汉大学口腔医院口腔颌面-头颈肿瘤外科 湖北 武汉 430079
  • 收稿日期:2023-07-03 出版日期:2024-01-28 发布日期:2024-01-22
  • 通讯作者: *贾俊,E-mail:junjia@whu.edu.cn
  • 作者简介:卜琳琳(1987~ ),男,山西临汾人,博士,副主任医师,主要从事口腔癌相关临床与基础研究。
  • 基金资助:
    武汉青年医学人才培养项目

Mandible Defect Reconstruction by Intraoral Anastomosis of Iliac Crest Bone Flap

BU Linlin1,2, ZHANG Hongyu1, CAO Leiming1, LIU Bing1,2, JIA Jun1,2*   

  1. 1. State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China;
    2. Department of Oral & Maxillofacial Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China
  • Received:2023-07-03 Online:2024-01-28 Published:2024-01-22

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摘要： 目的:介绍数字外科引导下利用口内血管吻合技术联合血管化游离髂骨瓣移植在颌骨重建中的临床操作与优势,探讨口内血管吻合技术的临床应用。方法:选取2022年武汉大学口腔医学口腔颌面外科3例因颌骨良性肿瘤需行颌骨切除并同期修复的患者,术前对患者进行颌骨及髂骨CT扫描,制定虚拟手术计划,设计、制作取骨截骨导板,手术切除肿瘤,其中2例为口内入路切除,1例为口外入路切除。截取髂嵴部带血管蒂骨瓣,以面动静脉为受区吻合血管与髂骨瓣血管蒂进行吻合,从而完成髂骨瓣对颌面部缺损的重建修复。随访患者术后恢复情况并进行评估。结果:3例手术均成功完成,其中2例患者无口外切口,1例患者仅有一处原发灶切除为口外切口。术后患者恢复良好,颌面部结构基本对称且美观。结论:口内血管吻合技术与髂骨瓣及虚拟手术计划相结合可以取得良好的术后结果。口内吻合技术不仅可以完成口内颌骨病灶切除后重建,对于需经口外入路切除病灶的病例也有一定优势。

关键词: 口内血管吻合, 髂骨瓣, 颌骨重建

Abstract: Objective: To introduce the operation and advantages of intraoral vascular anastomosis technology combined with vascularized iliac crest flap transplantation in mandibular reconstruction during the era of digital surgery, and to explore the clinical application of intraoral vascular anastomosis technology. Methods: Three patients with benign tumors of jawbones who underwent jawbone resection and simultaneous repair in the Department of Oral and Maxillofacial Surgery, School of Stomatology, Wuhan University in 2022 were selected. Preoperative CT scans of the mandible and ilium were performed on the patients. Virtual surgical planning was made and osteotomy cutting guides were designed and produced. Tumors in two cases were resected through intraoral approach and in one case was resected through extra-oral approach. Iliac crest flap with pedicle was harvested. The facial artery and vein were used as recipient vessels to perform vascular anastomosis with the vascular pedicle of the iliac crest flap to reconstruct and repair the mandibular defect. Follow-up visits were conducted to evaluate the postoperative recovery of patients. Results: All three surgeries were successful. Two patients had no extraoral incision, and one patient had only extra-oral incision because of the primary lesion resection. Patients recovered well postoperatively. The mandibular structure was basically symmetrical and aesthetic. Conclusion: The combination of intraoral anastomosis technology, iliac crest flap, and virtual surgical planning can achieve good postoperative results. Intraoral anastomosis technology can not only reconstruct mandibular lesions after intraoral resection, but also has certain advantages for cases requiring extra-oral approach to resect lesions.

Key words: intraoral vascular anastomosis, iliac crest bone flap, mandibular reconstruction