3D打印辅助设计个性化游离腓骨瓣成形修复上颌骨切除术后缺损

Application of computer-assisted design and three-dimensional printing technique in reconstruction of maxillary defects with individual free fibular flap

目的探讨3D打印辅助设计个性化游离腓骨瓣成形修复上颌骨切除术后缺损的疗效。方法回顾性分析2016年1月至2018年12月,首都医科大学附属北京同仁医院收治的13例上颌骨区肿瘤术后缺损患者的病历资料,其中男7例,女6例,年龄12~55岁。其中行上颌骨次全切除4例,全上颌骨切除9例。手术根据术前CT表现在上颌骨三维图像上模拟截骨切除范围,将健侧上颌骨镜像复制到患侧缺损处,再根据镜像后的骨形态设计个性化腓骨修复的3D模型,根据3D模型进行腓骨雕塑成形和上颌骨缺损修复。分别从口腔、鼻腔、眼功能及外形恢复等方面观察3D打印辅助设计个性化游离腓骨肌皮瓣成形修复上颌骨切除术后缺损的疗效。结果随访5~40个月,1例患者术后出现皮瓣危象皮瓣坏死,余12例皮瓣全部成活。13例患者随访期间,经CT或MRI证实均未见肿瘤复发。3例患者术后出现不同程度的腭瘘,余10例患者可经口进食,无鼻腔反流。11例患者发音效果满意。全部患者鼻腔通气良好。全部患者未出现视力下降和复视,眼位正常。术后外观恢复采用视觉模拟量表(VAS)进行评估。13例患者VAS平均数为8分,除1例皮瓣坏死患者,余12例患者对外形修复满意。结论3D打印辅助设计个性化游离腓骨瓣成形修复上颌骨切除术后缺损不仅能保全口腔、鼻腔和眼的功能,而且能获得较满意的外形恢复效果。

Objective To evaluate the application of computer-assisted design and three-dimensional printing technique in reconstruction of maxillary defects with individual free fibular flap.Methods A total of 13 patients,7 males and 6 females with age from 12 to 55 years old,underwent the reconstruction of maxillary defects after subtotal or total maxillectomy for benign or malignant tumors between January 2016 and December 2018 were reviewed.Ther were 4 cases of subtotal maxillectomy and 9 cases of total maxillectomy.Before operation,osteotomy line was planned on three-dimensional images.A three-dimensional individual resin fibula model based on mirror images of the healthy side maxilla was obtained to fabricate an anatomically adapted osteomyocutaneous fibula free flap using computer-assisted design and forming.Oral,nasal,and eye functions and facial appearance were evaluated.Results The 13 cases were followed up for 5-40 months,all flaps were alive except one due to flap failure and all cases were tumor free confirmed by CT or MRI.Ten patients could eat normal food without nasal food return,and 3 cases had palatal fistula.Eleven cases showed good speaking functional results.All cases had normal eye positions,no cases with diplopia and loss of vision.With evaluation by VAS,an average score of 8 was obtained,and most of patients were satisfied with their postoperative facial appearances.Conclusion Reconstruction of maxillary defects by free fibular flap designed by three-dimensional printing and computer-assisted technique not only restored oral,nasal and eye functions,but also showed satisfactory facial appearance.