虚拟手术辅助的血管化腓骨肌(皮)瓣行下颌骨精确重建

Using virtual surgery for accurate mandibular reconstruction with vascularized fibula osteomyocutaneous flap

目的 回顾性分析经虚拟手术辅助的血管化腓骨肌（皮）瓣行下颌骨大型缺损精确重建的患者,评估其术后效果.方法 2009年6月-2014年12月对42例不同类型的下颌骨缺损患者术前通过虚拟手术模拟下颌骨节段性切除、腓骨的截开和塑形,来选择最佳的腓骨截开线、骨块塑形的角度和需要切除的骨量.术中使用手术导板再现术前计划,实际重建效果与虚拟手术结果进行对比.术后1年对所有患者面部外形进行满意度评估.结果 42例患者术后随访显示重建的下颌骨均愈合良好、咬合关系正常,实际重建效果与虚拟手术结果基本一致.患者对面部外形恢复满意.结论 结合义齿修复,虚拟手术辅助的血管化腓骨肌（皮）瓣能精确重建下颌骨大型缺损的理想外形和良好功能.

Objective To review the clinical data of patients who underwent accurate mandibular reconstruction of large defect with vascularized fibula osteomycutaneous flap using virtual surgery and to evaluate the postoperative results. Methods From June 2009 to December 2014, 42 patients with mandibular defect were treated in our department. In virtual surgical planning, bilateral fibulae were automatically superimposed mandibular defect after segmental mandibulectomy to select the optimal osteotomy line and angle and the removed bone segment. Segmental mandibulectomy and mandibular reconstruction were performed using guided templates to replicate the virtual planning. Actual reconstruction results were compared with those of virtual surgery. The patients were asked to assess their satisfaction with facial appearance at 1 year after operation. Results Good bony unions and occlusion were observed in 42 patients. The actual results were basically in accordance with those of virtual surgery. All patients reported excellent or good facial appearances at 1 year postoperatively. Conclusion The ideal contour of neo-mandible and good function with dental rehabilitation can be obtained after accurate mandibular reconstruction of large defect with vaseularized fibula osteomycutaneous flap using virtual surgery.