颈阔肌皮瓣联合3D打印预成型钛重建板在口腔癌整复术中的疗效评价

Effect evaluation of platysma myocutaneous flap combined with 3D printing pre-shaped reconstructive Ti-plate in reconstructive operation for oral cancer

目的：探讨颈阔肌皮瓣联合3D 打印预成型钛重建板在口腔癌术中同期修复软组织缺损和重建下颌骨连续性的可行性及应用价值。方法108例口腔癌早期的患者分别纳入对照组（55例）和实验组（53例）。在施行扩大切除口腔癌癌灶和下颌骨截骨术后，对照组采用颈阔肌皮瓣联合钛重建板同期修复软组织的缺损和重建下颌骨的连续性；实验组则采用颈阔肌皮瓣联合3D 打印预成型钛重建板方法修复。结果对照组中25例伤口Ⅱ期愈合、无并发症，5例伤口感染，9例皮瓣远端坏死，6例钛板外露，8例钛钉松脱，2例继发术侧颞下颌关节功能紊乱综合征。实验组中仅1例皮瓣远端坏死，经换药后愈合；术后随访1～2年，患者自我评价外形及功能恢复情况令人满意。结论采用颈阔肌皮瓣联合3D 打印预成型钛重建板方法行口腔癌整复术，不但节约手术时间、住院费用，还可能降低伤口感染、钛板外露、皮瓣坏死等并发症的发生率，值得在临床上推广应用。

Objective To investigate the feasibility and application value of platysma myocutaneous flap combined with 3D print‐ing pre‐shaped reconstructive Ti‐plate in the simultaneous‐repair of soft tissue defect and mandibular continuity reconstruction in the patients with oral cancer .Methods One hundred and eight cases of early stage oral cancer were repectively included into the control group （55 cases） and experiment group （53 cases） .After the resection of oral cancer and mandible osteotomy ,the control group was adopted the platysma myocutaneous flap combined with reconstructive Ti‐plate to conduct the simultaneous‐repair of soft tissue defect and mandibular continuity reconstruction ,while the experimental group adopted platysma myocutaneous flap combining 3D printing pre‐shaped reconstructive Ti‐plate method .Results In the control group ,25 cases had the stage Ⅱ wound healing with‐out complications ,5 cases had wound infection ,9 case had the flap distal end necrosis ,6 cases had Ti‐plate exposure ,8 cases had screw loosening and 2 cases had secondary temporomandibular joint dysfunction syndrome .In the experimental group ,only 1 case had flap distal end necrosis ,which was healed after dressing change .All the patients were satisfactory with the profile and function during a follow‐up period of 1 - 2 years .Conclusion Adopting platysma myocutaneous flap and 3D printing pre‐shaped reconstruc‐tive Ti‐plate for performing the correction operation of oral cancer not only saves the operative time and hospitalization cost ,but also reduces the incidence rate of complications such as wound infection ,Ti‐plate exposure and skin flap necrosis ,which is worth to be popularized and applied in clinic .