游离腓骨瓣重建下颌骨术后对称性的CBCT评价

CBCT evaluation of symmetry after mandibular reconstruction with free fibula flap

目的 应用CBCT观察数字化辅助游离腓骨瓣重建下颌骨术后的下颌骨对称性变化。方法 选取数字化辅助游离腓骨瓣重建下颌骨节段性骨缺损的患者13例,记录患者术后3、6、12个月的临床观察指标,并应用invivo5.0软件对数据进行三维重建,测量颌面硬组织及下颌骨线距、角度,利用SPSS 25.0分析患者术后不同时间点的下颌骨对称性。结果 术后3、6、12个月,手术侧颞下颌关节后间隙和上间隙均大于非手术侧(P<0.05);术后12个月,非手术侧下颌骨体线距及下颌骨升支角度大于手术侧(P<0.05)。结论 CBCT可作为评估游离腓骨瓣重建下颌骨术后对称性的有效手段,重建术后临床效果满意,但远期手术侧髁状突出现前下移位,下颌骨对称性出现差异。

Objective To evaluate the symmetrical of mandible after digital assisted free fibula flap reconstruction by CBCT. Methods Thirteen patients with segmental mandibular defects were reconstructed with digital-assisted free fibula flap. The clinical observation indexes of the patients at 3, 6 and 12 months after operation were recorded. The CBCT data were reconstructed by invivo5.0 software, and the line distance and angle of maxillofacial hard tissue and mandible were measured. SPSS25.0 was used to analyze the mandibular symmetry at different time points. Results At 3, 6 and 12 months after operation, the posterior space and superior space of temporomandibular joint of the operated side were larger than those of the non-operated side(P <0.05);At 12months after operation, the mandibular body distance and the angle of mandibular ramus in the non-operative side were larger than those in the operated side(P<0.05). Conclusion CBCT can be used as an effective method to evaluate the symmetry of mandible reconstruction with free fibula flap. The clinical results after reconstruction are satisfactory, but the long-term condyle is displaced anterior and downward, and the symmetry of mandible is different.