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基于数字技术的游离腓骨瓣在下颌骨缺损中的临床应用

[Clinical application of free fibular flap based on digital technology in mandibular defects].

作者信息

Sun Libo, Lan Yuyan, Zhou Hangyu, Fu Guangxin, Yao Zhihao, Li Yong, Li Junyi

机构信息

Department of Oral and Maxllofacial Surgery,Hospital of Stomatology,Southwest Medical University,Luzhou,646000,China.

Department of Oral and Maxllofacial Surgery,the Affiliated Hospital of Southwest Medical University.

出版信息

Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2020 Jul;34(7):626-629. doi: 10.13201/j.issn.2096-7993.2020.07.012.

Abstract

To investigate the application of free fibular flap based on digital technology in mandibular defects. Eight cases of mandibular defects underwent virtual surgery and guide plate design before operation. The mandibular osteotomy guide plate, fibula plastic guide plate and mandibular reconstruction model were prepared by rapid prototyping technology. The individualized reconstruction titanium plates were prefabricated on the mandibular reconstruction model. Based on the guide plates and the individualized reconstruction titanium plates, the mandibular defects were repaired accurately. At the same time, CT angiography was used to observe the variation of peroneal artery. For patients with soft tissue defects, the superficial position of the point going out muscle of perforator vessels was located, and the skin flaps were designed to repair the soft tissue defect. The free fibular flaps survived in all patients. The guide plates were successfully implanted, the position of the individualized reconstruction titanium plates were accurate, and the occlussions were well recovered. Preoperative CT angiography was carried out without complication in all patients, the desired anatomy was adequately demonstrated in all patients. The superficial position of the point going out muscle of perforator vessels during operation were basically in accordance with those detected by CT angiography. The free fibular flaps based on digital technology can successfully repair mandibular defects with good aesthetic and functional results.

摘要

探讨基于数字技术的游离腓骨瓣在下颌骨缺损修复中的应用。8例下颌骨缺损患者术前进行虚拟手术及导板设计。采用快速成型技术制备下颌骨截骨导板、腓骨塑形导板及下颌骨重建模型。在该模型上预制个体化重建钛板。基于导板及个体化重建钛板,精确修复下颌骨缺损。同时,采用CT血管造影观察腓动脉变异情况。对于合并软组织缺损的患者,确定穿支血管出肌点的体表位置,设计皮瓣修复软组织缺损。所有患者游离腓骨瓣均成活。导板顺利植入,个体化重建钛板位置准确,咬合关系恢复良好。所有患者术前CT血管造影均无并发症,均清晰显示了所需解剖结构。术中穿支血管出肌点的体表位置与CT血管造影探测结果基本相符。基于数字技术的游离腓骨瓣可成功修复下颌骨缺损,获得良好的美学及功能效果。

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