交互式医学图像控制系统(MIMICS)在下颌骨肿瘤切除及缺损重建中的应用

Application of Materialise's Interactive Medical Image Control System(Mimics)in the Mandibular Tumor Resection and Defect Reconstruction

目的：探讨交互式医学图像控制系统（MIMICS）在下颌骨肿瘤切除,腓骨瓣修复重建下颌骨缺损的应用价值,为术前进行精确设计手术方案及达到术后良好的重建效果提供可靠依据。方法：选取2014年11月-2015年12月收治的下颌骨肿瘤需重建的10例患者。术前行上下颌骨及供区小腿螺旋CT扫描,将DICOM数据导入交互式医学图像控制系统（MIMICS）,观察肿瘤确定安全范围、模拟肿瘤切除、镜像恢复患侧、腓骨瓣模拟重建、预测重建效果。术中按术前设计方案切除肿瘤、腓骨瓣制备塑形、钛板固定、腓骨瓣固定就位。结果：全部手术按术前模拟顺利完成,移植腓骨瓣术后全部成活。术后1、3、6、9、12个月随访复查,行曲断或CT复查,结果示10例患者腓骨瓣位置良好,开口度2-3指,供区小腿腓骨创面愈合良好未见明显并发症。患者对术后面部外形及小腿功能的恢复均为满意。结论：在下颌骨肿瘤切除及缺损重建中利用CT影像资料,采用交互式医学图像控制系统（MIMICS）实现在计算机屏幕前制定手术方案,进行术前手术评估和术后重建效果预测,提高下颌骨肿瘤切除的准确性及腓骨重建颌骨的连续性和对称性。

Objective：To investigate the applicative value of the interactive medical image control system＇s（MIMICS）in mandibular tumor resection and reconstruction of mandibular defect with fibula flap and provide reliable basis for precise preoperative designing plan and desirable postoperative reconstructive result.Methods：Between November2014 and December2015,ten patients with mandibular tumor were treated in our department.Their mandible,maxilla and the donor leg received spiral CT scans preoperatively.DICOM data generated from the scanning were imported into MIMICS to observe the safe resection margin,simulate tumor resection,restore the effected side,reconstruct with fibula flap and predict the outcome.According to the preoperative design,the tumor was resected completely,fibula flap was shaped,titanium plate was bent and fixed,and the fibula flap went to position during operation.Results：All operations were completed successfully according to the preoperative plan,and all fibula flaps survived after the operations.Postoperative followups were done 1,3,6,9and 12 months after operation and panoramic radiograph and CT were taken.All fibula flaps were in good position.Mouth opening of the patients varied from 2to 3fingers.All the donor leg fibula wounds healed well,with no obvious complications.All patients were satisfied with the facial aesthetics and the donor leg function.Conclusion：Pre-surgery planning including presurgical evaluation and outcome prediction with the aid of MIMICS which makes use of preoperative CT data in the mandibular tumor resection and defect reconstruction increases the accuracy of the tumor resection,and improves continuity and symmetry of the mandible.