摘要：

目的: 探讨虚拟手术及基于模拟结果形成的数字化手术导板在腓骨肌皮瓣重建下颌骨缺损中的应用。方法: 回顾性分析2018年7月—2020年8月间梅州市人民医院口腔颌面外科行下颌骨节段切除并同期行腓骨肌皮瓣修复的17例下颌骨肿瘤患者,将患者分为研究组(数字化导板手术组,11例)及对照组(常规手术组,6例)。其中,研究组通过Proplan CMF软件(Materialise公司,比利时)模拟手术过程,并基于模拟结果通过Mimics软件(Materialise公司,比利时)设计手术导板,并将其打印成形以指导手术过程;对照组按常规流程进行手术。对比2组腓骨塑形时间、皮瓣缺血时间、皮瓣成活情况、术后咬合关系、开口度及面部外形的情况。利用Mimics软件测量研究组中实际手术结果与虚拟手术结果的位置误差。结果: 研究组11例和对照组6例的皮瓣均成活。研究组下颌骨的切除、重建及骨肌皮瓣的切取均在模型和导板的辅助下顺利完成。研究组腓骨塑形时间明显小于对照组(P<0.05),腓骨瓣平均缺血时间明显小于对照组(P<0.01);2组术后开口度情况差异无统计学意义(P>0.05)。研究组实际手术结果与模拟手术结果对比,颌骨位置的平均误差约为1.5 mm。结论: 虚拟手术及基于模拟结果生成的数字化手术导板能更好地指导腓骨肌游离皮瓣重建下颌骨缺损手术的进行,节省腓骨塑形时间,减少腓骨瓣的缺血时间,有利于皮瓣成活,术后面型、开口度及咬合关系的恢复,值得临床推广。

关键词: 虚拟手术, 数字化导板, 下颌骨缺损, 腓骨肌游离皮瓣, 修复重建

Abstract:

Objective: This study aimed to describe the application of virtual operation and digital operation splint based on simulation results in reconstruction of mandibular defect with fibula musculocutaneous flap. Methods: A total of seventeen patients with mandible tumors who was hospitalized in Meizhou People′s Hospital from July 2018 to August 2020 and received mandibular segmental resection combined with fibular musculocutaneous flap repair were retrospectively selected and randomly divided into the research group (n=11, digital operation splint group) and the control group (n=6, routine treatment group). In the research group, Proplan CMF software(Materialise company, Belgium) was applied to simulate the procedure, and according to the simulation results, Mimics software(Materialise company, Belgium) was used to form the operation splint, and the printed operation splint could be used to instruct the operation process. In the control group, routine operation was underwent according to the conventional procedures. The fibular shaping time, flap ischemia time, flap survival situation, postoperative occlusion relationship, mouth opening degree and facial appearance between two groups were compared. The position errors of actual and virtual surgical results were measured by Mimics software in the research group. Results: The transplanted flaps of 11 patients in the research group and 6 patients in the control group were all survived. In this study, the resection and reconstruction of mandible and the resection of osteomyocutaneous flaps in the research group were successfully completed with the assistance of the model and the splint. The fibular shaping time in the research group was significantly shorter than that in the control group(P<0.05). The average ischemia time of fibula muscle flap in the research group was shorter than that in the control group (P<0.01). There was no significant difference in postoperative mouth opening between the two groups(P>0.05). In research group, Mimics software was used to overlap and compare actual surgical results with simulation results, showing the average position error was about 1.5 mm. Conclusion: Virtual operation and the generated digital operation splint based on the simulation results can better guide the free fibula muscle flap for reconstruction of mandibular defect, which is worth promoting due to saved fibula shaping time, reduced fibula flap ischemia time, better survival of skin flap, narrower postoperative facial contour, and ideal mouth opening degree and occlusion relation.

Key words: virtual operation, digital splint, reconstruction of mandibular defect, free fibula musculocutaneous flap, repair and reconstruction

中图分类号: 

• R782