上海口腔医学

上海口腔医学 ›› 2021, Vol. 30 ›› Issue (6): 618-623.doi: 10.19439/j.sjos.2021.06.011

• 论著 • 上一篇    下一篇

改良数字化导板技术在下颌骨缺损腓骨肌皮瓣修复中的应用评价

蔡嫚1,3, 王义洲1, 祝庆海1, 侯辰兴1, 韩微1, 王晨星1, 李怀奇1, 田宏伟2,*, 叶金海1,*   

  1. 1.南京医科大学口腔疾病研究江苏省重点实验室,南京医科大学附属口腔医院 口腔颌面外科,江苏 南京 210029;
    2.阜阳市人民医院 口腔科,安徽 阜阳 236000;
    3.南京医科大学附属宿迁第一人民医院 口腔科,江苏 宿迁 223800
  • 收稿日期:2021-08-26 修回日期:2021-10-15 发布日期:2022-03-09
  • 通讯作者: 田宏伟,E-mail:2857413944@qq.com;叶金海,E-mail:yejinhai@njmu.edu.cn。*共同通信作者
  • 作者简介:蔡嫚（1989-）,女,硕士,E-mail: 15052783708@163.com
  • 基金资助:
    国家自然科学基金（81371123）; “科教强卫工程”医学重点人才项目（ZDRCA2016087）; 江苏高校优势学科建设工程资助项目（2018-87）

Clinical application of modified digital guide plate technique in repair of mandibular defect with fibular myocutaneous flap

CAI Man1,3, WANG Yi-zhou1, ZHU Qing-hai1, HOU Chen-xing1, HAN Wei1, WANG Chen-xing1, LI Huai-qi1, TIAN Hong-wei2, YE Jin-hai1   

  1. 1. Jiangsu Key Laboratory of Oral Diseases, Department of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital of Nanjing Medical University. Nanjing 210029, Jiangsu Province;
    2. Department of Stomatology, Fuyang People's Hospital. Fuyang 236000, Anhui Province;
    3. Department of Stomatology, The Affiliated Suqian First People's Hospital of Nanjing Medical University. Suqian 223800, Jiangsu Province, China
  • Received:2021-08-26 Revised:2021-10-15 Published:2022-03-09

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摘要： 目的: 探讨改良数字化导板技术在下颌骨节段切除及腓骨肌皮瓣修复重建术中的临床应用效果。方法: 选择2016年1月—2020年1月在南京医科大学附属口腔医院及阜阳市人民医院口腔科行下颌骨节段性切除同期行血管化腓骨肌皮瓣修复的16例患者,均为良性病变,随机分为常规导板技术组（常规组）和改良数字化导板组（改良组）,每组各8例。常规组患者行术前常规检查,常规导板设计手术方案。改良组患者术前行下颌骨锥形束CT（CBCT）及双侧下肢CT血管造影（CTA）检查,数据导入数字化导板软件后模拟手术过程,打印预期重建的3D模型,制作术中准确定位的导板,以达到重建后腓骨骨段精确定位。2组患者术后2周复查CBCT,选取髁突位置及下颌骨形态变化为参考,对比分析患者手术前、后CT数据,比较2组患者髁突位置及下颌骨形态变化。根据临床表现,比较2组患者于术前、后开口度与开口型变化,以及下颌骨重建修复手术效果差异。采用患者满意度调查表,让患者在术后3个月左右、义齿修复治疗前,对余留牙咀嚼功能、语言功能及面部外形做出自主等级评价。采用SPSS 25.0软件包对数据进行t检验或秩和检验。结果: 2组患者手术均顺利完成。改良组患者髁突位置变化明显小于常规组。改良组患者下颌骨形态变化小于常规组。改良组患者术后开口度及开口型恢复更优,患者对咀嚼功能及面部外形满意度高于常规组,2组患者发音功能满意度无显著差异。结论: 改良数字化导板技术在血管化腓骨肌皮瓣精确修复下颌骨缺损的应用中有较高的临床指导价值,可简化手术过程,减少术后并发症,提升下颌骨的重建精度。

关键词: 数字化导板技术, 手术导板, 下颌骨缺损, 腓骨肌皮瓣

Abstract: PURPOSE: To investigate the clinical value of modified digital guide plate technique in mandibular segmental resection and fibular flap reconstruction. METHODS: Sixteen patients were randomly divided into conventional guide plate technology group and improved digital guide plate group, who underwent mandibular segmental resection and vascularized fibular myocutaneous flap repair in the Affiliated Stomatological Hospital of Nanjing Medical University and Fuyang People's Hospital, from January 2016 to January 2020, eight cases in each group. The lesions of the mandible were all benign. Patients in the conventional guide technology group received routine examination before operation, and conventional guide designed the operation plan. Patients in the improved digital guide group underwent cone-beam CT (CBCT) of mandible and CTA of both lower limbs before operation. The data were imported into the digital guide software to simulate the operation process, and reconstructed 3D model was printed to make intraoperative guide for accurate positioning. Patients in both groups were reexamined with CBCT 2 weeks after operation, the condylar position change and mandible morphological change were selected as the reference. Through comparative analysis of preoperative and postoperative CT, the condylar position change, the mandible morphological change, mouth opening degree and opening type were analysed, and the operation effect of the two groups was compared. Before denture restoration, the patient satisfaction questionnaire was used to evaluate the masticatory function, speech function and facial appearance 3 months after operation. SPSS 25.0 software package was analyzed for different types of data by Student's t test and Wilcoxon Rank-Sum test. RESULTS: The two groups of patients were successfully operated. The condylar position change and mandible morphological change of the improved digital guide group were significantly less than that of the conventional guide group. The satisfaction degree of masticatory function and facial appearance in the improved digital guide group was significantly higher than that of the conventional guide group. There was no significant difference in the satisfaction of speech function between the two groups of patients. CONCLUSIONS: Improved digital guide plate technique has high clinical value in use of vascularized fibular myocutaneous flap to accurately repair the mandibular defects, which simplifies the operation process, reduces postoperative complications, and improves the accuracy of mandibular reconstruction.

Key words: Digital guide technology, Surgical guide plate, Mandibular defect, Fibular myocutaneous flap

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