虚拟手术及3D打印导板在腓骨肌皮瓣修复 下颌骨缺损中的临床应用

Clinical application of virtual surgery and 3D-printed plates in reconstruction of mandibular defects with fibula myocutaneous flap

摘要:

目的：将虚拟手术及3D打印导板用于腓骨肌皮瓣修复下颌骨缺损，实现下颌骨缺损的个性化精确修复，并探讨3D打印导板在提高下颌骨缺损修复精确度方面所发挥的作用。方法：10例下颌骨病变患者在术前模拟完成病变切除及腓骨移植重建，设计制作3D打印导板，术中应用导板重建下颌骨。术后使用图像融合技术对比实际手术与模拟手术的差异大小，对其差异值进行统计分析。结果：3D打印导板术中就位顺利，患者面型及咬合关系恢复良好。测量结果显示10例患者实际手术与模拟手术最大截骨误差为（1.57±0.80） mm。结论：数字化3D打印导板应用于腓骨肌皮瓣修复下颌骨缺损，能获得较好的精准度。使用髁突定位导板固定下颌残端，能有效稳定患侧髁突位置，提高重建精确度。

Abstract:

Objective：To achieve accurate individualized reconstruction of mandibular defects with fibula myocutaneous flap based on virtual surgery and 3D-printed plates，and to explore the role of 3D-printed plates in improving the reconstructive accuracy of mandibular defects. Methods：The resection of mandibular lesions and reconstruction of fibular graft in 10 patients was performed using computer simulation before surgery. The 3D-printed plates were designed and produced in reconstruction of mandible during surgery. The difference between practical and simulative operations was determined using image fusion technology after surgery and the differ－ence values were analyzed statistically. Results：The 3D-printed plates were successfully implanted. The features and occlusal relationship of patients were well recovered. The measurements showed that the maximum margin of error between practical and sim－ulative osteotomy was （1.57±0.80） mm. Conclusion：The ap－plication of digital 3D-printed plates ensure a high accuracy in reconstruction of mandibular defects with fibula myocutaneous flap. The application of condylar positioning plates in fixing residual mandible effectively stabilized condylar position on the affected side and improved the reconstructive accuracy.