CAJ | 학술논문

目的：评价快速原型及种植导板在下颌骨肿瘤切除节段性缺损同期血管化自体骨移植修复重建过程中的作用。方法22例下颌骨肿瘤的患者，术前行螺旋CT扫描并三维重建成像，采用快速原型技术制成与患者颌骨形态相同的实体及镜像模型，根据临床和影像学表现在模型上确定病变切除范围、预成型重建钛板；采用模型压模法制作外科种植导板，按设计行下颌骨节段切除，血管化腓骨肌瓣采用双层平行法或髂骨肌瓣修复骨缺损，依照重建板和种植导板进行移植骨塑型、摆位，确定牙槽重建高度和种植位点，固定移植骨及重建板于正常下颌骨，并进行血管吻合。术后定期复查随访。结果基于快速原型进行的模型外科可准确地辅助真实手术操作，由预制的重建钛板及种植导板引导进行的移植骨分段塑型、固定后所重建的颌骨形态与下颌骨外形匹配并获得适应的种植骨床；6例患者同期行种植体植入，7例行二期种植体植入，随访期共13例行义齿修复；术后患者面部外形对称，术后影像学显示下颌骨形态良好，牙槽高度和方向适合种植及义齿修复要求。术后定期复查显示患者面型和功能逐渐恢复或改善。结论快速原型技术为下颌骨肿瘤切除术后骨缺损个体化修复重建提供了有力的技术支持，基于原型制作的种植导板的应用可较好地重建义齿修复所适应的组织结构，从而为功能性颌骨重建提供了保证。
목적：평개쾌속원형급충식도판재하합골종류절제절단성결손동기혈관화자체골이식수복중건과정중적작용。방법22례하합골종류적환자，술전행라선CT소묘병삼유중건성상，채용쾌속원형기술제성여환자합골형태상동적실체급경상모형，근거림상화영상학표현재모형상학정병변절제범위、예성형중건태판；채용모형압모법제작외과충식도판，안설계행하합골절단절제，혈관화비골기판채용쌍층평행법혹가골기판수복골결손，의조중건판화충식도판진행이식골소형、파위，학정아조중건고도화충식위점，고정이식골급중건판우정상하합골，병진행혈관문합。술후정기복사수방。결과기우쾌속원형진행적모형외과가준학지보조진실수술조작，유예제적중건태판급충식도판인도진행적이식골분단소형、고정후소중건적합골형태여하합골외형필배병획득괄응적충식골상；6례환자동기행충식체식입，7례행이기충식체식입，수방기공13례행의치수복；술후환자면부외형대칭，술후영상학현시하합골형태량호，아조고도화방향괄합충식급의치수복요구。술후정기복사현시환자면형화공능축점회복혹개선。결론쾌속원형기술위하합골종류절제술후골결손개체화수복중건제공료유력적기술지지，기우원형제작적충식도판적응용가교호지중건의치수복소괄응적조직결구，종이위공능성합골중건제공료보증。
Objective To explore the applications of rapid prototyping (RP) technique and implant-guide plate in mandibular reconstruction by vascularized autologous bone graft after segmental mandibulectomy. Methods Preoperative spirals CT scan and three-dimensional reconstruction imaging was taken in 22 patients with mandibular tumors. The stereolithographic model of mandible was made using RP technique and reverse engineering(RE)from computed tomography(CT)data. After designed the cut line on the model, the reconstruction plate was pre-bent to fit model, then implant-guide plate was incused according to the model. Segmental mandibulectomy and mandibular reconstruction with double barrel vascularized fibula or illac osteo-myocutaneous flap were performed according to preoperative design and guide plate. All patients with follow-up more than 1 year were evaluated postoperative functional and aesthetic results. Results As many as 7 double-barrel vascularized fibula and 15 vascularized iliac flaps were applied. Seven patients were performed simultaneous implantation,and six patients accepted secondary implantation postoperatively. A total of 13 patients achieved denture restoration during the follow-up period. Satisfactory facial symmetry was restored, and no severe complications occurred in all patients during 1 year follow-up period at least. Conclusions Mandibular reconstruction with vascularized autologous bone graft is facilitated using the CAD/RP technique. Satisfactory esthetic results and masticatory function are achieved. RP model-based surgical templates have contributed to functional mandibular reconstruction.