Department of Oral and Maxillofacial Surgery/Faculty of Medicine KU Leuven, University Hospitals Leuven, Campus Sint-Rafaël, Kapucijnenvoer 33, 3000 Leuven, Belgium.
Department of Oral and Maxillofacial Surgery/Faculty of Medicine KU Leuven, University Hospitals Leuven, Campus Sint-Rafaël, Kapucijnenvoer 33, 3000 Leuven, Belgium; Department of Imaging & Pathology, OMFS IMPATH Research Group, Kapucijnenvoer 33, 3000 Leuven, Belgium.
Oral Oncol. 2019 Oct;97:69-75. doi: 10.1016/j.oraloncology.2019.07.022. Epub 2019 Aug 17.
We evaluated the accuracy of computer-assisted mandibular reconstructions.
We retrospectively reviewed data for 26 patients who had mandibular reconstruction with a microvascular free fibula flap, January 2015 to June 2018. Postoperative mandible models were obtained from computed tomography scans. After registering the models to the corresponding preoperative plan, we performed comparative measurements. Patients were grouped by condylar involvement and subdivided based on number of fibular segments used for reconstruction. For each segment, we measured length and osteotomy angles. For the final postoperative outcome, we compared intercoronoid, intergonial, and anteroposterior distances and intersegmental plane shift.
Means (SD) for deviation of each osteotomy angle and fibular segment length were 1.98° (2.98) and 1.78 mm (2.69), respectively, remaining constant across subgroups. Other mean values were as follows: intercoronoid distance deviation, 3.86 mm (range, 0.20-11.21 mm); intergonial distance deviation, 3.14 mm (range, 0.05-8.28 mm); anteroposterior distance deviation, 2.92 mm (range, 0.03-8.49 mm); and intersegmental plane shift, 11.00° (range, 2.76-24.15°). Where the condyle was preserved, the intercoronoid and intergonial deviation means differed significantly (respectively 5.02 mm and 4.88 mm, both P < 0.05) for one-segmented and three-segmented fibular reconstructions. Furthermore, reconstructions involving the condylar region compared with condyle preservation showed significantly different intersegmental plane shifts (7.18°; P < 0.05).
Computer-assisted surgery provides cutting guides for obtaining accurate fibular segments, but current fixation methods lead to inaccuracies and reproducibility errors. In multisegmental transfer with condylar involvement, computer-assisted fixation is recommended to ensure accuracy of the preoperative plan.
评估计算机辅助下颌骨重建的准确性。
我们回顾性分析了 2015 年 1 月至 2018 年 6 月期间 26 例接受游离腓骨瓣微血管重建下颌骨的患者资料。术后通过 CT 扫描获得下颌骨模型。将模型与相应的术前计划配准后，进行对比测量。根据髁突受累情况对患者进行分组，并根据用于重建的腓骨段数量进行亚组划分。对每个节段测量长度和截骨角度。对于最终的术后结果，比较了双侧髁突间、双侧下颌角间以及前后向距离和节段间平面移位。
每个截骨角度和腓骨段长度的偏差平均值分别为 1.98°（2.98）和 1.78 mm（2.69），在各亚组中保持不变。其他平均值如下：双侧髁突间距离偏差为 3.86 mm（范围，0.20-11.21 mm）；双侧下颌角间距离偏差为 3.14 mm（范围，0.05-8.28 mm）；前后向距离偏差为 2.92 mm（范围，0.03-8.49 mm）；节段间平面移位为 11.00°（范围，2.76-24.15°）。髁突保留时，单节段和三节段腓骨重建的双侧髁突间和双侧下颌角间距离偏差差异有统计学意义（分别为 5.02 mm 和 4.88 mm，均 P < 0.05）。此外，髁突区重建与髁突保留相比，节段间平面移位差异有统计学意义（7.18°；P < 0.05）。
计算机辅助手术可提供获取精确腓骨段的截骨导板，但目前的固定方法会导致精度和重复性误差。在涉及髁突的多节段转移中，建议使用计算机辅助固定以确保术前计划的准确性。
