摘要：

微血管化骨组织移植是颌骨肿瘤切除后颌骨重建的一个重要里程碑。传统游离骨肌皮瓣移植虽然即刻重建了颌骨，但需要6~18个月后才能完成牙列修复。牙列缺损严重影响了患者的生活质量，并给患者造成较大的心理负担。随着“4P”医学时代的到来，对于手术的可预测性和个体化提出了更高的要求。颌骨与牙列同日重建（jaw-in-a-day）是目前完整颌骨重建的最高水平，能够满足上述要求，即在虚拟手术与计算机辅助设计和计算机辅助制造（computer aided design/computer aided manufacture，CAD/CAM）的支持下同期完成颌骨肿瘤切除、血管化骨肌皮瓣游离移植、牙种植体植入及临时义齿修复。颌骨与牙列同日重建即刻重建了患者颌面部的形态与功能，体现了“以咬合为导向的修复重建”的理念；但其围手术期管理与手术流程、手术技巧与故障排除等亟待完善。

关键词: 颌骨与牙列同日重建, 虚拟手术, 计算机辅助设计和计算机辅助制造

Abstract:

Microvascularized bone tissue transplantation is an important milestone in reconstruction of jaws after resection of jaw tumors. Although the traditional free osteomyocutaneous flap transplantation immediately reconstructs the jaw, it takes 6 to 18 months to restore the dentition. Dentition defect seriously affects the quality of life of patients and puts a great psychological burden on patients. With the advent of“4P” medicine era, surgery forwards higher requirements on predictability and personalization. Simultaneous reconstruction of jaw and dentition(jaw-in-a-day) is the state of the art in complete jaw reconstruction at present, which can meet the above requirements. Jaw-in-a-day means with the support of virtual surgery and computer aided design/computer aided manufacture（CAD/CAM）, combining jaw tumor resection, vascularized osteomyocutaneous free flap transplantation, dental implant placement and provisional denture restoration in one surgery. The shape and function of the patient are reconstructed immediately in jaw-in-a-day, which reflects an “occlusion-driven reconstruction” notion; However, perioperative management and surgical process, and surgical skills and trouble-shooting need to be elucidated.

Key words: jaw-in-a-day, virtual surgery, CAD/CAM