以咬合为导向的CAD/CAM技术辅助腓骨肌皮瓣修复下颌骨缺损

CAD/CAM-assisted occlusion-oriented repair of mandibular defects with fibular musculocutaneous flaps

目的:探讨以咬合为导向的计算机辅助设计及制造技术(computer-aided design/manufacturing,CAD/CAM技术)辅助腓骨肌皮瓣在修复下颌骨缺损中的作用。方法:6例下颌骨节段性切除的患者,术前CT扫描获取下颌骨及移植腓骨的CT数据及获取患者的咬合关系。计算机辅助切除下颌骨病变后,利用健侧数据设计腓骨的形状和位置,在腓骨上模拟种植体植入,恢复牙列及咬颌关系,根据上牙列进一步调整和校对腓骨的位置。计算机辅助设计下颌骨病变切除截骨导板、腓骨塑形导板,3D打印技术制备导板及下颌骨修复后模型、并在模型上预成型重建钛板,指导手术实施。结果:截骨导板和腓骨塑形导板能引导下颌骨病变的准确切除和腓骨精准快速塑形,简化手术操作,缩短手术时间。术后6例患者术区均一期愈合,腓骨肌皮瓣存活。术后随访6~24个月,结果显示腓骨瓣与下颌骨愈合良好,患者面部对称,咬合良好,张开度及张口型正常。供区小腿功能运动正常,患者满意度高。结论:以咬合为导向的CAD/CAM技术辅助下腓骨肌皮瓣下颌骨重建具有简化手术操作、缩短手术时间、提高下颌骨病变的切除和腓骨切取塑形的精确度,减少传统镜像技术下颌骨重建设计的偏差,术后咬合功能和形态恢复良好的优点。

Objective: To explore the effect of occlusion-oriented therapy assisted by computer-aided design/manufacturing(CAD/CAM) on mandibular defect repair with fibular musculocutaneous flaps. Methods: The CT dataof the mandible and transplanted fibula and occlusal relationship were obtained by CT scanning in 6 patients withsegmental mandibular resection before the operation. With computer simulation, mandibular lesions were removed;then the shape and position of the fibula were determined using the data of the healthy side of the mandible;next,dental implants were implanted into the fibula to restore the dentition and occlusal relationship;and then the posi-tion of the fibula was further adjusted and calibrated according to the upper dentition. With computer assistance, thecutting guide for mandibular osteotomy and fibular shaping guide were designed;the 3 D printing technology wasused to print the guides and mandibular reconstruction model, and fabricate the reconstruction titanium plate accord-ing to the model to guide the implementation of the operation. Results: The cutting guide and shaping guide couldguide accurate removal of mandibular lesions as well as precise and rapid shaping of the fibula, and simplify the op-eration procedures. All the 6 patients had primary healing of surgical wounds, and the fibular musculocutaneous flaps survived. They were followed up for 6 to 24 months: the fibular flaps and mandible healed well;the patients hadsymmetrical faces, good occlusion, and normal degrees and shape of mouth opening;the patients had normal functionof donor calves and high degrees of satisfaction. Conclusion: CAD/CAM-assisted occlusion-oriented mandibular re-construction with fibular musculocutaneous flaps can simplify operation procedures, shorten operation time, improvethe accuracy of removal of mandibular lesions and shaping of the fibula, reduce the deviation of mandibular recon-struction design with the traditional mirroring technique, and well restore occlusal function and the shape of the man-dible after operation.