虚拟手术设计在下颌骨放射性骨坏死手术治疗中的应用

Application of virtual surgical planning in the surgical treatment of osteoradionecrosis of mandible

目的分析虚拟手术设计对下颌骨放射性骨坏死手术治疗的价值,为临床应用提供参考。方法 2017年9月—2018年6月间,采用3D虚拟手术软件CMF Proplan 2.0对13例下颌骨放射性骨坏死患者进行术前评估及虚拟手术设计,设计并3D打印手术导板,术中完成病灶骨切除、腓骨塑形、移植骨定位;部分病例同期行种植体植入,术后3~6个月完成义齿修复。对患者的一般资料、围手术期资料、疗效等信息进行分析。结果所有患者均顺利完成手术,游离腓骨肌皮瓣存活率100%(13/13),1例患者出现并发症(皮瓣边缘部分坏死)。随访时间为7~15个月,中位时间为10个月。所有患者治疗均达到治愈效果。开口度增加≥1 cm、0.5 cm≤开口度增加<1 cm、开口度增加<0.5 cm的例数分别为5、6、2例。影像学检查示12例患者骨质愈合良好,1例术后7个月尚在愈合中。得牙率为92.3%(12/13),其中3例行同期种植修复,咀嚼效率平均值为56.11%±7.12%(42.03%~67.83%)。结论虚拟手术设计是下颌骨放射性骨坏死手术治疗的有效方法,能降低手术风险,更有效地进行下颌骨外形及功能修复。

Objective To analyze the value of virtual surgical planning in the surgical treatment of osteoradionecrosis of the mandible and to provide a reference for clinical practice. Methods From September 2017 to June 2018, 13 patients with mandibular osteoradionecrosis were evaluated preoperatively using the 3 D virtual surgery software CMF Proplan 2.0. The surgical guide was designed and 3 D printed. Bone resection, fibula shaping and bone graft localization were completed during the operation. In some cases, implants were implanted at the same time, and denture restoration was completed 3 to 6 months after surgery. Patients' general information, perioperative data, and efficacy evaluation were analyzed. Results All patients underwent surgery successfully. The survival rate of the free fibula musculocutaneous flap was 100%(13/13), and one patient had complications(partial necrosis at the edge of the flap). The follow-up period was 7 to 15 months, and the median time was 10 months. All patients achieved a healing effect. The number of cases with an increase in mouth opening ≥ 1 cm, 0.5 cm ≤ mouth opening increase 1 cm, and mouth opening increase 0.5 cm were 5, 6, and 2, respectively. An imaging examination showed that 12 patients had good bone healing, and 1 patient did not completely heal 7 months after operation. The denture restoration was 92.3%(12/13), of which 3 cases were implanted and repaired at the same time. The average chewing efficiency was 56.11%± 7.12%(42.03%-67.83%).Conclusion Virtual surgical planning is an effective method for the surgical treatment of mandibular osteoradionecrosis, which can reduce the risk of surgery and more effectively perform mandibular shape and function repair.