数字化导板在血管化腓骨肌皮瓣修复下颌骨缺损中的临床应用研究

Clininal application of digital guide plate in the treatment of mandibular defect with vascularized fibular myocutaneous flap

目的探讨数字化导板在血管化腓骨肌皮瓣修复下颌骨缺损中的临床应用效果。方法选择2016年1月至2018年10月大连市口腔医院口腔颌面外科肿瘤病区收治的下颌骨肿瘤需手术切除病灶并行腓骨肌皮瓣修复缺损的患者6例,其中成釉细胞瘤3例、多房角化囊肿1例、鳞状细胞癌2例。所有患者术前均进行下颌骨及左侧腓骨的三维CT扫描,并建立下颌骨及腓骨三维模型,使用3D数字化打印技术制作下颌骨截骨导板、腓骨截骨及塑形导板,术前进行重建钛板的预成型。所有手术均由分工明确的相同2名医生操作,术中使用截骨导板截除下颌骨肿瘤和应用截骨、塑形导板塑造腓骨,指导手术完成。结果所有病例全部手术成功,病灶组织按计划准确切除,术中腓骨肌皮瓣制备准确,术后腓骨肌皮瓣全部成活,患者术后咬合关系恢复良好,面部外型恢复理想,无明显并发症的发生。结论应用数字化截骨及塑形导板可简化手术过程、节省手术时间,使手术过程中的并发症明显降低,并能达到精确修复,提高血管化腓骨肌瓣修复颌骨缺损的治疗效果。

Objective To discuss the clinical effect of digital guide plate in repairing mandibular defect with vascularized fibular myocutaneous flap.Methods From January 2016 to October 2018,6 patients(3 with ameloblastoma,1 with multilocular keratocyst and 2 with squamous cell carcinoma)with mandibular tumors requiring fibula myocutaneous flaps were treated in the oral and maxillofacial surgery oncology ward of Dalian Stomatological Hospital.All patients underwent three-dimensional CT reconstruction of mandible and left fibula before operation and three-dimensional mandibular and fibula models were established.The mandibular osteotomy guide plate and fibula osteotomy plastic guide plate were made by 3D digital printing technology,and the titanium plate was pre-formed before operation.All operations were performed by the same two doctors with a clear division of labor.The osteotomy guide plate was used to remove mandibular tumors and the osteotomy plastic guide plate was used to shape the fibula to guide the operation.Results All cases were successfully operated.The lesion tissue was resected accurately according to the plan.The fibula myocutaneous flaps were prepared accurately during the operation.All the fibula myocutaneous flaps survived after the operation.The occlusal relationship of the patients recovered well after the operation.The facial appearance recovered well without obvious complications.Conclusion The application of digital osteotomy and plastic guide plate can simplify the operation process,save operation time,reduce complications and achieve accurate repair,which improves the treatment effect of vascularized fibular myocutaneous flap in repairing jaw defects.