在使用虚拟规划的带血管骨瓣进行一期下颌骨重建时，利用SPECT-CT确定炎症性颌骨病变中足够的骨切除边缘。
Determination of adequate bony resection margins in inflammatory jaw pathologies using SPECT-CT in primary mandibular reconstruction with virtually planned vascularized bone flaps.
作者信息
Winnand Philipp, Lammert Matthias, Ooms Mark, Heitzer Marius, Katz Marie Sophie, Peters Florian, Raith Stefan, Mottaghy Felix M, Hölzle Frank, Modabber Ali
机构信息
Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, D-52074, Aachen, Germany.
Institute of Pathology, University Hospital RWTH Aachen, Pauwelsstraße 30, D-52074, Aachen, Germany.
出版信息
Clin Oral Investig. 2025 Jan 28;29(1):93. doi: 10.1007/s00784-025-06170-2.
OBJECTIVES
In advanced stages of osteoradionecrosis, medication-related osteonecrosis of the jaw, and osteomyelitis, a resection of sections of the mandible may be unavoidable. The determination of adequate bony resection margins is a fundamental problem because bony resection margins cannot be secured intraoperatively. Single-photon emission computed tomography (SPECT-CT) is more accurate than conventional imaging techniques in detecting inflammatory jaw pathologies. The clinical benefit for virtual planning of mandibular resection and primary reconstruction with vascularized bone flaps has not yet been investigated. This study aimed to evaluate the determination of adequate bony resection margins using SPECT computed tomography (SPECT-CT) for primary microvascular reconstruction of the mandible in inflammatory jaw pathologies.
MATERIALS AND METHODS
The cases of 20 patients with inflammatory jaw pathologies who underwent primary microvascular mandibular reconstruction after the bony resection margins were determined with SPECT-CT were retrospectively analyzed. The bony resection margins determined by SPECT-CT were histologically validated. The sensitivity was calculated as the detection rate and the positive predictive value as the diagnostic precision. Radiological ossification of the vascularized bone flaps with the mandibular stumps was assessed at least 6 months after reconstruction. The clinical course was followed for 12 months.
RESULTS
The determination of adequate bony resection margins with SPECT-CT yielded a sensitivity of 100% and a positive predictive value of 94.7%. Of all the bony resection margins, 97.4% were radiologically sufficiently ossified with the vascularized bone flap and showed no complications in the clinical course.
CONCLUSIONS
SPECT-CT could increase the probability of determining adequate bony resection margins.
CLINICAL RELEVANCE
SPECT-CT could have a beneficial clinical impact in the context of primary microvascular bony reconstruction in inflammatory jaw pathologies.
目的
在放射性骨坏死、药物性颌骨坏死及骨髓炎的晚期，下颌骨部分切除术可能难以避免。确定足够的骨切除边缘是一个基本问题，因为术中无法确保骨切除边缘的安全。单光子发射计算机断层扫描（SPECT-CT）在检测颌骨炎性病变方面比传统成像技术更准确。虚拟规划下颌骨切除及带血管骨瓣一期重建的临床益处尚未得到研究。本研究旨在评估使用SPECT计算机断层扫描（SPECT-CT）确定足够的骨切除边缘，用于炎性颌骨病变下颌骨一期微血管重建的效果。
材料与方法
回顾性分析20例炎性颌骨病变患者的病例，这些患者在通过SPECT-CT确定骨切除边缘后接受了下颌骨微血管一期重建。对SPECT-CT确定的骨切除边缘进行组织学验证。计算敏感性作为检测率，计算阳性预测值作为诊断精度。重建后至少6个月评估带血管骨瓣与下颌残端的放射性骨化情况。随访临床病程12个月。
结果
使用SPECT-CT确定足够的骨切除边缘，敏感性为100%，阳性预测值为94.7%。在所有骨切除边缘中，97.4%在影像学上与带血管骨瓣充分骨化，且临床病程中未出现并发症。
结论
SPECT-CT可提高确定足够骨切除边缘的概率。
临床意义
在炎性颌骨病变的一期微血管骨重建中，SPECT-CT可能具有有益的临床影响。
Zotero 插件