Castro-Núñez Jaime, Shelton Jared M, Snyder Susan, Sickels Joseph Van
Division of Oral and Maxillofacial Surgery, University of Kentucky, Lexington, Kentucky.
Institución Universitaria Colegios de Colombia. Bogotá, Colombia.
Craniomaxillofac Trauma Reconstr. 2018 Jun;11(2):150-156. doi: 10.1055/s-0037-1601865. Epub 2017 Apr 19.
Severely atrophic mandible fractures are frequently a challenge to treat. Virtual surgical planning (VSP) uses three-dimensional computed tomographic (CT) scans that can be translated into stereolithographic models to fabricate surgical templates, facilitating intraoperative procedures. The purpose of this article is to describe the reconstruction of two cases of severe atrophic mandible fracture using VSP. Two elderly edentulous/partially dentate patients who presented with fractures of their mandibles and who underwent reconstruction using VSP were included. Both had Class III atrophy at the region of the fracture. While both fractures were complex, the mechanism of injury differed with one being a tractor accident and the other being a pathologic fracture. Both patients presented with critical medical conditions. CT scans were obtained on both. The displaced segments were aligned virtually using mirror images and the midline of the maxilla. Three-dimensional models were fabricated to allow preoperative contouring of 2.5-mm reconstruction plates. Patients were operated under general anesthesia and fractures reduced and stabilized with 2.5-mm reconstruction plates placed at the lateral border of the mandible. Average treatment time for both patients was a little over 2 hours. There was good reduction with both. VSP is a valuable tool to assess and reduce complex fractures with less surgical time and predictable results.
严重萎缩性下颌骨骨折的治疗常常具有挑战性。虚拟手术规划（VSP）利用三维计算机断层扫描（CT），这些扫描可转化为立体光刻模型以制作手术模板，从而便于术中操作。本文旨在描述使用VSP重建两例严重萎缩性下颌骨骨折的情况。纳入了两名下颌骨骨折且接受VSP重建的老年无牙/部分缺牙患者。两者在骨折区域均为Ⅲ级萎缩。虽然两处骨折均很复杂，但损伤机制不同，一例为拖拉机事故，另一例为病理性骨折。两名患者均伴有严重的基础疾病。对两人均进行了CT扫描。使用镜像和上颌骨中线虚拟对齐移位的骨段。制作三维模型以进行术前2.5毫米重建钢板的塑形。患者在全身麻醉下接受手术，骨折复位并用置于下颌骨外侧缘的2.5毫米重建钢板固定。两名患者的平均治疗时间略超过2小时。两者均实现了良好的复位。VSP是一种有价值的工具，可用于评估和复位复杂骨折，减少手术时间并获得可预测的结果。
