计算机辅助设计在股前外侧皮瓣口腔颌面部重建中的应用
[Application of computer-assisted design for anterolateral thigh flap in oral and maxillofacial reconstruction].
作者信息
Wang S J, Zhang W B, Yu Y, Xie X Y, Yang H Y, Peng X
机构信息
Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China.
Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology, Beijing 100081, China.
出版信息
Beijing Da Xue Xue Bao Yi Xue Ban. 2020 Feb 18;52(1):119-123. doi: 10.19723/j.issn.1671-167X.2020.01.019.
OBJECTIVE
To investigate the feasibility and accuracy of using digital technology to design anterolateral thigh flap (ALTF) in oral and maxillofacial defect reconstruction.
METHODS
Ten cases underwent oral and maxillofacial defects reconstruction with ALTFs in Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from June 2019 to Oct. 2019 were enrolled. There were 7 males and 3 females with the mean age of 47.1 years. Preoperative high frequency color Doppler ultrasound examination was performed to detect the perforators of ALTF. CT data of the thigh was imported in DICOM (digital imaging and communications in medicine) format to the Proplan CMF 3.0 software (Materalise, Belgium), then virtual harvest of ALTF was performed according to the points of perforators detected by high frequency color Doppler ultrasound and the virtual flap volume was calculated by Proplan CMF 3.0 software. ALTF was harvested followed by preoperative virtual design, and the actual flap volume of ALTF was measured by the draining method during the surgery. Finally, the accuracy rate of using high frequency color Doppler ultrasound to detect perforators of ALTFs was calculated, and the differences between the virtual flap volume measured by Propaln CMF 3.0 software and the actual volume of ALTF by the draining method were compared using paired samples T test.
RESULTS
Fifteen perforators in the flaps area of 10 patients who underwent oral and maxillofacial defects reconstruction with ALTFs were detected by high frequency color Doppler ultrasound, and 16 perforators were identified during the surgery, with the accuracy rate of 87.5%. The flaps size ranged from 5 cm×7 cm to 8 cm×15 cm, all the 10 flaps survived. The donor sites were primarily closed without skin graft, and no surgery complication was found on the donor site. The mean flap volume measured by Propaln CMF 3.0 software was 71.4 cm³ (range: 36.1-188.4 cm³), and the mean volume measured by the draining method was 70.7 cm³ (range: 38.3-172.5 cm³). There was no significant difference between the virtual flap volume measured by Propaln CMF 3.0 software and the actual volume measured by draining method (t=0.318; P=0.758).
CONCLUSION
Preoperative virtual design of ALTF has good feasibility and accuracy and can be used to guide the harvest of ALTF during operation.
目的
探讨利用数字技术设计股前外侧皮瓣（ALTF）用于口腔颌面部缺损修复的可行性及准确性。
方法
选取2019年6月至2019年10月在北京大学口腔医学院口腔颌面外科行ALTF修复口腔颌面部缺损的10例患者。男7例，女3例，平均年龄47.1岁。术前采用高频彩色多普勒超声检查探测ALTF的穿支。将大腿的CT数据以DICOM（医学数字成像和通信）格式导入Proplan CMF 3.0软件（比利时Materialise公司），然后根据高频彩色多普勒超声探测到的穿支位置进行ALTF的虚拟切取，并由Proplan CMF 3.0软件计算虚拟皮瓣体积。按术前虚拟设计切取ALTF，术中采用排水法测量ALTF的实际皮瓣体积。最后计算高频彩色多普勒超声探测ALTF穿支的准确率，采用配对样本t检验比较Proplan CMF 3.0软件测量的虚拟皮瓣体积与排水法测量的ALTF实际体积之间的差异。
结果
10例行ALTF修复口腔颌面部缺损患者皮瓣区域经高频彩色多普勒超声探测到15支穿支，术中发现16支穿支，准确率为87.5%。皮瓣大小为5 cm×7 cm至8 cm×15 cm，10例皮瓣全部成活。供区均一期缝合，未植皮，供区未出现手术并发症。Proplan CMF 3.0软件测量的皮瓣平均体积为71.4 cm³（范围：36.1 - 188.4 cm³），排水法测量的平均体积为70.7 cm³（范围：38.3 - 172.5 cm³）。Proplan CMF 3.0软件测量的虚拟皮瓣体积与排水法测量的实际体积之间差异无统计学意义（t = 0.318；P = 0.758）。
结论
ALTF术前虚拟设计具有良好的可行性和准确性，可用于指导术中ALTF的切取。
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