数字化技术辅助游离组织皮瓣在颌骨缺损重建中的应用

Application of computer aided surgery technique in free flaps reconstruction of jaw defect

目的 通过比较3种数字化外科转化技术（CAS）,明确应用不同数字化外科技术转化方法在颌骨重建手术中的适应证及其优势及不足. 方法 本研究收集了自2011年6月至2014年2月于本课题组进行数字化外科设计并进行手术的病例35例,根据其转化方法不同分为3组：①导航手术组,共5例,均为下颌骨缺损重建.②模型/导板/模板引导手术组,共12例,其中2例为上颌骨缺损重建,10例为下颌骨缺损重建.③导板联合导航手术组,共18例,其中9例上颌骨缺损重建,9例下颌骨缺损重建. 结果 以上3种方法均能较好地转化术前的虚拟设计信息,使手术获得较理想的重建效果,患者对术后的外形及功能均较满意.其中导板联合导航手术组误差最小,转化的精确度最高. 结论 数字化外科辅助颌骨缺损重建可获得较满意的外观和功能重建效果,根据不同的手术目的以及缺损范围选择适宜的数字外科设计转化方法可有效提高手术效率、增加手术精确性与安全性.

Objective To explore the indication of CAS technique base on reviewing cases which used different transfer methods,and evaluate the advantages and disadvantages of each transfer method.Methods During August 2011 and Febreary 2014,there were 35 patients received surgical jaw reconstruction under the aid of CAS.According to the different transfer methods used,those cases were divided into 3 groups：①Navigational surgery group：5 cases,all were mandible defect reconstruction.②Stereolithographic Model/Template/Implant group：12 cases （including 2 maxilla defect reconstruction and 10 mandible defect reconstruction）.③Navigation and template group：18 cases （including 9 maxilla defect reconstructions and 9 mandible defect reconstructions）.Results All 3 methods could effectively transfer the virtual surgical planning information,the reconstruction achieved better outcome.All patients were satisfied with the post-operative aesthetical and functional outcome.Conclusion Computer aided surgery technique can improve aesthetic and functional reconstruction outcome in jaw defect reconstruction,leading to higher efficiency,accuracy and safety.It is highly recommended to select a proper transfer method according to the reconstruction goal and volume of defect.