虚拟计划的旋髂深动脉皮瓣手术执行的准确性及其在咀嚼康复中的适宜性。

Accuracy of the surgical execution of virtually planned deep circumflex iliac artery flaps and their appropriateness for masticatory rehabilitation.

机构信息

Department of Oral, Maxillofacial and Facial Plastic Surgery, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.

Department of Orthodontics, University Witten/Herdecke, Private Universität Witten/Herdecke GmbH, Alfred-Herrhausen-Straße 45, 58448, Witten, Germany.

出版信息

Head Face Med. 2024 Aug 13;20(1):42. doi: 10.1186/s13005-024-00444-y.

DOI:10.1186/s13005-024-00444-y

PMID:39135061

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11321092/

Abstract

BACKGROUND

Tumorous diseases of the jaw demand effective treatments, often involving continuity resection of the jaw. Reconstruction via microvascular bone flaps, like deep circumflex iliac artery flaps (DCIA), is standard. Computer aided planning (CAD) enhances accuracy in reconstruction using patient-specific CT images to create three-dimensional (3D) models. Data on the accuracy of CAD-planned DCIA flaps is scarce. Moreover, the data on accuracy should be combined with data on the exact positioning of the implants for well-fitting dental prosthetics. This study focuses on CAD-planned DCIA flaps accuracy and proper positioning for prosthetic rehabilitation.

METHODS

Patients post-mandible resection with CAD-planned DCIA flap reconstruction were evaluated. Postoperative radiograph-derived 3D models were aligned with 3D models from the CAD plans for osteotomy position, angle, and flap volume comparison. To evaluate the DCIA flap's suitability for prosthetic dental rehabilitation, a plane was created in the support zone and crestal in the middle of the DCIA flap. The lower jaw was rotated to close the mouth and the distance between the two planes was measured.

RESULTS

20 patients (12 males, 8 females) were included. Mean defect size was 73.28 ± 4.87 mm; 11 L defects, 9 LC defects. Planned vs. actual DCIA transplant volume difference was 3.814 ± 3.856 cm³ (p = 0.2223). The deviation from the planned angle was significantly larger at the dorsal osteotomy than at the ventral (p = 0.035). Linear differences between the planned DCIA transplant and the actual DCIA transplant were 1.294 ± 1.197 mm for the ventral osteotomy and 2.680 ± 3.449 mm for the dorsal (p = 0.1078). The difference between the dental axis and the middle of the DCIA transplant ranged from 0.2 mm to 14.8 mm. The mean lateral difference was 2.695 ± 3.667 mm in the region of the first premolar.

CONCLUSION

The CAD-planned DCIA flap is a solution for reconstructing the mandible. CAD planning results in an accurate reconstruction enabling dental implant placement and dental prosthetics.

摘要

背景

颌骨肿瘤疾病需要有效的治疗，通常需要连续切除颌骨。使用微血管骨瓣进行重建，如旋髂深动脉皮瓣（DCIA），是标准的治疗方法。计算机辅助规划（CAD）通过使用患者特定的 CT 图像创建三维（3D）模型，提高了重建的准确性。关于 CAD 规划的 DCIA 皮瓣准确性的数据很少。此外，应该将这些数据与植入物的精确定位数据结合起来，以实现良好的牙修复体适配。本研究重点关注 CAD 规划的 DCIA 皮瓣的准确性及其对修复体的精确定位。

方法

评估接受 CAD 规划的 DCIA 皮瓣重建的下颌骨切除术后患者。将术后放射学衍生的 3D 模型与 CAD 计划中的 3D 模型对齐，以比较骨切开位置、角度和皮瓣体积。为了评估 DCIA 皮瓣是否适合牙修复体，在 DCIA 皮瓣的支撑区和中间牙槽嵴创建一个平面。然后旋转下颌骨关闭口腔，并测量两个平面之间的距离。

结果

纳入 20 名患者（12 名男性，8 名女性）。平均缺损大小为 73.28±4.87mm；11 个 L 型缺损，9 个 LC 型缺损。计划的与实际的 DCIA 移植体积差异为 3.814±3.856cm³（p=0.2223）。背侧骨切开处与计划角度的偏差明显大于腹侧（p=0.035）。腹侧骨切开处计划的 DCIA 移植与实际的 DCIA 移植之间的线性差异为 1.294±1.197mm，背侧骨切开处为 2.680±3.449mm（p=0.1078）。牙轴与 DCIA 移植体中部之间的差异范围为 0.2mm 至 14.8mm。第一前磨牙区的平均侧向差异为 2.695±3.667mm。