数字化外科及增材制造技术在血管化髂骨肌瓣重建下颌骨缺损中的应用

Application of digital surgery and additive manufacturing in mandibular reconstruction with vascularized iliac crest flap

目的探讨数字化外科及增材制造技术辅助下血管化髂骨肌瓣重建下颌骨的临床治疗效果。方法分析2012年11月至2019年11月就诊于武汉大学口腔医院头颈肿瘤外科行血管化髂骨肌瓣重建下颌骨缺损的142例患者的临床资料。其中采用数字化外科及增材制造技术制造医学模型辅助手术89例,采用传统方法53例。比较两组手术相关指标及术后效果评价指标。定量资料采用两独立样本t检验,定性资料采用χ2检验。结果与传统手术组比较,数字化设计组手术时间明显缩短[(7.42±1.24) h比(6.69±1.42) h,t=3.109,P<0.05],术后颌面外形满意认可程度更高(χ2=6.775,P<0.05),患侧髁突位置更加稳定(χ2=4.737,P<0.05),差异均有统计学意义;术后住院天数(t=1.332,P>0.05)、总住院天数(t=-0.856,P>0.05)、咬合关系(χ2=0.066,P>0.05)两组间比较差异无统计学意义,但术前住院天数明显延长[(7.36±3.25) d比(8.69±3.86) d,(t=-2.097,P<0.05),差异有统计学意义。结论数字化外科技术辅助手术可有效缩短血管化髂骨肌瓣重建下颌骨的时间,同时提高了重建后的临床治疗效果,值得进一步推广使用。

Objective To compare efficiency and clinical outcomes of digital surgery and additive manufacturing(AM)with conventional experience method in mandibular reconstruction with vascularized iliac crest flap.Methods We retrospectively reviewed records of 142 patients who underwent mandibular reconstruction with vascularized iliac crest flap at the Department of Oral and Maxillofacial-Head and Neck Oncology,School and Hospital of Stomatology,Wuhan University,from November 2012 to November 2019.Patients were categorized by the type of reconstructive technique:conventional experience method group(n=53,November 2012 to December 2015)and digital surgery group(n=89,January 2016 to November 2019).Surgical factors and clinical outcomes were compared between two groups.Results Operation time in digital surgery group was decreased from(7.42±1.24)h to(6.69±1.42)h(t=3.109,P<0.05),and digital surgery group had better maxillofacial appearance(χ2=6.775,P<0.05),more stable condylar position(χ2=4.737,P<0.05),while preoperative hospital stay was increased from(7.36±3.25)d to(8.69±3.86)d(t=-2.097,P<0.05).There were no significant differences in patients’days of hospitalization after operation(t=1.332,P>0.05),overall length of stay(t=-0.856,P>0.05),and residual occlusal relationship between two groupsχ2=0.066,(P>0.05).Conclusion AM decrease operation time and improve clinical outcomes of mandibular reconstruction with vascularized iliac crest flap.