计算机辅助设计腓骨肌皮瓣联合股前外侧皮瓣修复双侧下颌骨放射性骨坏死

doi:10.12439/kqhm.1005-4979.2026.03.009

摘要/Abstract

摘要：

目的：

探讨计算机辅助设计腓骨肌皮瓣联合股前外侧皮瓣在较大范围下颌骨放射性骨坏死伴颌面部软组织缺损修复中的临床效果。

方法：

回顾性分析2019年1月至2024年10月中南大学湘雅医学院附属株洲医院收治的口腔癌综合治疗后发生双侧下颌骨放射性骨坏死伴颌面部软组织缺损患者的临床资料（男5例，女1例），均排除肿瘤复发。采用计算机辅助设计结合游离腓骨肌皮瓣及股前外侧皮瓣进行缺损重建，观察并记录皮瓣存活、创口愈合、下颌骨形态恢复及供区与受区并发症情况。

结果：

术后随访6~12个月，6例股前外侧皮瓣全部存活，5例腓骨肌皮瓣完全存活，1例腓骨肌皮瓣皮岛边缘发生部分坏死，经处理后愈合，所有患者未发生严重并发症。所有患者颌骨及面部软组织愈合良好，术后面型恢复满意，双侧颜面部基本对称。

结论：

对于较大范围下颌骨放射性骨坏死伴颌面部软组织缺损，采用计算机辅助设计联合腓骨肌皮瓣及股前外侧皮瓣进行修复是一种安全、有效的重建方法。

关键词: 计算机辅助设计, 放射性骨坏死, 下颌骨, 腓骨肌皮瓣, 股前外侧皮瓣, 缺损修复

Abstract:

Objective:

To investigate the clinical efficacy of computer-aided design (CAD) fibular myocutaneous flap combined with an anterolateral thigh flap in the reconstruction of extensive mandibular osteoradionecrosis accompanied by maxillofacial soft tissue defects.

Methods:

A retrospective analysis was performed on the clinical data of patients who developed bilateral mandibular osteoradionecrosis with maxillofacial soft tissue defects after comprehensive treatment for oral cancer from January 2019 to October 2024 at Zhuzhou Hospital, Affiliated to Xiangya School of Medicine, Central South University. Five males and one female were included, all with confirmed absence of tumor recurrence. CAD combined with free fibular myocutaneous and anterolateral thigh flaps was used for defect reconstruction. Flap survival, wound healing, mandibular contour restoration, and donor- and recipient-site complications were evaluated.

Results:

During a postoperative follow-up period of 6 to 12 months, all six anterolateral thigh flaps survived completely, five fibular myocutaneous flaps survived completely, and one fibular myocutaneous flap showed partial marginal necrosis of the skin island, which healed after treatment. No serious complications were observed. All patients achieved good healing of the mandible and facial soft tissues, with satisfactory postoperative facial contour restoration and essentially symmetric bilateral facial appearance.

Conclusion:

For extensive mandibular osteoradionecrosis with maxillofacial soft tissue defects, the use of CAD combined with free fibular myocutaneous and anterolateral thigh flaps is a safe and effective reconstructive method.

Key words: computer-aided design, osteoradionecrosis, mandible, fibular myocutaneous flap, anterolateral thigh flap, defect reconstruction

丁云波, 朱郁文, 马壮, 姚建. 计算机辅助设计腓骨肌皮瓣联合股前外侧皮瓣修复双侧下颌骨放射性骨坏死[J]. 《口腔颌面外科杂志》, 2026, 36(3): 233-239.

DING Yunbo, ZHU Yuwen, MA Zhuang, YAO Jian. Computer-aided design of a fibular myocutaneous flap combined with an anterolateral thigh flap for reconstruction of bilateral mandibular osteoradionecrosis[J]. Journal of Oral and Maxillofacial Surgery(CN), 2026, 36(3): 233-239.

https://journal06.magtech.org.cn/Jweb_joms/CN/Y2026/V36/I3/233

图/表 7

表1 患者临床资料

Table 1 Clinical characteristics of the patients

编号	性别	年龄/岁	临床分型	临床分期	累及部位
1	男	54	重型	Ⅲ	双侧下颌骨体部、下颌正中部
2	男	47	重型	Ⅲ	双侧下颌骨体部、下颌正中部
3	男	45	重型	Ⅲ	左侧下颌角、双侧下颌骨体部
4	女	53	重型	Ⅲ	双侧下颌角、左侧下颌骨体部
5	男	65	重型	Ⅲ	双侧下颌角、下颌正中部
6	男	60	重型	Ⅲ	双侧下颌骨体部、下颌正中部

图1 计算机辅助设计及三维打印建模过程 A.下颌骨模型打印；B.左侧下颌骨截骨导板设计；C.右侧下颌骨截骨导板设计；D.截骨范围模拟；E.腓骨截骨导板设计；F.下颌骨重建模拟。

Figure 1 CAD and three-dimensional‌ printing modeling process

图2 三维打印模型及截骨导板

Figure 2 Three-dimensional printed model and osteotomy guides

图3 术前口腔全景片

Figure 3 Preoperative panoramic radiograph

图4 术前下颌骨CT平扫及三维重建 A.双侧下颌骨呈虫噬状改变，边界不清晰；B.三维重建显示下颌骨骨质明显缺损。

Figure 4 Preoperative plain CT scan and three-dimensional reconstruction of the mandible

图5 下颌骨病灶切除、重建及游离皮瓣制备 A.术中左侧下颌骨情况；B.术中右侧下颌骨情况；C.术中病灶正面照；D.根据截骨导板切除死骨；E.重建钛板植入；F.腓骨截骨及塑形；G.塑形后的腓骨；H.腓骨肌皮瓣及股前外侧皮瓣；I.双侧下颌骨坏死标本。

Figure 5 Resection of the mandibular lesion, reconstruction, and harvesting of free flaps

图6 手术前后口内及面部情况 A.术前口内病灶；B.术前面部皮肤瘘管；C.术后口内情况；D.术后面部外观情况。

Figure 6 Intraoral and facial appearance before and after surgery

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