CAJ | 학술논문

目的介绍应用ProPlan CMF软件、计算机虚拟手术切除下颌骨病灶、设计数字化腓骨瓣修复下颌骨缺损中的方法,并评价其疗效. 方法选取2013年3月1日至2014年1月31日收治的19例病灶累及下颌骨的患者,男12例,女7例,年龄21 ～ 73岁,中位年龄54岁,其中下颌骨放射性骨坏死7例,下颌骨成釉细胞瘤6例,下牙龈鳞癌4例,下颌骨鳞癌2例.术前行下颌骨及供区小腿螺旋CT扫描,将数据导入ProPlanCMF软件,根据肿瘤性质、骨破坏范围模拟下颌骨病灶的切除、腓骨瓣制备以及重建位置,并制作手术导板,术中在导板的引导下行下颌骨病灶的切除、腓骨瓣的制备塑形、钛支架的弯制及固定、腓骨瓣的就位. 结果 19例患者均按照术前设计顺利完成手术,术中下颌骨病灶切除和腓骨塑形均在术前设计的截骨导板引导下完成,恶性肿瘤患者切缘均为阴性,术前设计制作的腓骨就位导板使得塑形后的多段腓骨可快速而精确就位固定,上、下颌咬合关系良好,手术时间4.5 ～7.0 h,平均5.5h.术后腓骨肌皮瓣全部成活.除2例放射性骨坏死患者出现颌下区局部切口愈合不良,经换药处理后4周愈合,其余患者均Ⅰ期愈合,无并发症发生.患者术后随访3个月～1年,未见肿瘤复发及患者死亡,所有患者对颌面外形、咬合关系和咀嚼功能满意,开口度2.0～4.0 cm.复查曲面断层片或CT片显示腓骨瓣位置良好,下颌关节髁状突均在关节窝内正常位置.19例患者小腿腓骨供区无并发症,术后1周可早期下床活动,术后2～3个月行走基本正常. 结论应用ProPlan CMF软件进行计算机虚拟手术设计和导板制作,大大简化了手术操作,尤其是腓骨的截骨塑形与颌骨缺损的空间关系匹配,提高了下颌骨重建手术的精确度,值得临床推广.
목적 개소응용ProPlan CMF연건、계산궤허의수술절제하합골병조、설계수자화비골판수복하합골결손중적방법,병평개기료효. 방법 선취2013년3월1일지2014년1월31일수치적19례병조루급하합골적환자,남12례,녀7례,년령21 ～ 73세,중위년령54세,기중하합골방사성골배사7례,하합골성유세포류6례,하아간린암4례,하합골린암2례.술전행하합골급공구소퇴라선CT소묘,장수거도입ProPlanCMF연건,근거종류성질、골파배범위모의하합골병조적절제、비골판제비이급중건위치,병제작수술도판,술중재도판적인도하행하합골병조적절제、비골판적제비소형、태지가적만제급고정、비골판적취위. 결과 19례환자균안조술전설계순리완성수술,술중하합골병조절제화비골소형균재술전설계적절골도판인도하완성,악성종류환자절연균위음성,술전설계제작적비골취위도판사득소형후적다단비골가쾌속이정학취위고정,상、하합교합관계량호,수술시간4.5 ～7.0 h,평균5.5h.술후비골기피판전부성활.제2례방사성골배사환자출현합하구국부절구유합불량,경환약처리후4주유합,기여환자균Ⅰ기유합,무병발증발생.환자술후수방3개월～1년,미견종류복발급환자사망,소유환자대합면외형、교합관계화저작공능만의,개구도2.0～4.0 cm.복사곡면단층편혹CT편현시비골판위치량호,하합관절과상돌균재관절와내정상위치.19례환자소퇴비골공구무병발증,술후1주가조기하상활동,술후2～3개월행주기본정상. 결론 응용ProPlan CMF연건진행계산궤허의수술설계화도판제작,대대간화료수술조작,우기시비골적절골소형여합골결손적공간관계필배,제고료하합골중건수술적정학도,치득림상추엄.
Objective To introduce the application and assess the outcome of ProPlan CMF software in virtual surgery of mandibular resection and reconstruction with vascularized fibular graft.Methods Nineteen patients were performed mandibular resection,and immediate reconstruction with free fibular graft by application of ProPlan CMF software between March 1,2013 and January 31,2014,including 7 cases of osteoradionecrosis,6 cases of adamantoblastoma,4 cases of carcinoma of gingiva,2 cases of intra-osseous carcinoma of mandible.There were 12 males and 7 females,with an age range of 21-73 years (median,54 years).In each case,three-dimensional spiral CT scan of mandible and fibula was obtained before operation.The CT data were imported into the ProPlan CMF software and the virtual surgical planning was performed.After that,the mandibular rapid prototyping and surgical guide plates were made according to customized design.The segmental resection of mandible,titanium plate bending,fibular molding,insetting and fixing were then carried out by using these surgical guide plates.Results Operations were undertaken successfully according to preoperative design in all nineteen patients and negative margin was detected by intraoperative frozen section.The fibula was cut,shaped and fixed accurately.The operations took 4.5-7.0 hours (mean,5.5 hours).Primary healing of incision was obtained without complications except fistula in 2 cases of osteoradionecrosis,which were resolved with local wound care after 4 weeks.19 patients were followed up between 3 months to 1 year and all patients were alive with disease free.All patients were satisfactory with their maxillofacial appearance,occlusion and function.The ranges of mouth opening was 2.0-4.0 cm.The postoperative panoramic radiographs or CT scan showed perfect situation and contour of fibular graft.Healing of the donor site occurred without significant complications.All patients started early postoperative ambulation,and walked normally after 2 or 3 months.Conclusion The application of ProPlan CMF software in virtual surgical design and guide plates creation can simplify the operation,and improve the accuracy of mandibular resection and reconstruction,especially the spatial relationship of the mandible and the fibula graft.It is worth promotion widely in clinical practice.