中国口腔颌面外科杂志

中国口腔颌面外科杂志 ›› 2021, Vol. 19 ›› Issue (5): 469-473.doi: 10.19438/j.cjoms.2021.05.016

• 临床总结 • 上一篇    下一篇

虚拟手术计划在经口内入路行下颌骨切除及精确重建中的应用：附9例报道

杨鑫, 吕明明, 李军*, 孙坚*   

  1. 上海交通大学医学院附属第九人民医院 口腔颌面-头颈肿瘤科,上海交通大学口腔医学院, 国家口腔医学中心,国家口腔疾病临床医学研究中心,上海市口腔医学重点实验室,上海 200011
  • 收稿日期:2021-02-20 修回日期:2021-05-11 出版日期:2021-09-20 发布日期:2021-10-20
  • 通讯作者: 孙坚,E-mail:jianjian60@yahoo.com;李军,E-mail:13801753852@163.com。*共同通信作者
  • 作者简介:杨鑫（1984-）,男,博士,住院医师,E-mail:yangxin0512@hotmail.com

Application of virtual surgical planning in transoral mandibulectomy and accurate mandible reconstruction: report of 9 consecutive cases

YANG Xin, LYU Ming-ming, LI Jun, SUN Jian   

  1. Department of Oromaxillofacial Head and Neck Oncology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine;; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology. Shanghai 200011, China
  • Received:2021-02-20 Revised:2021-05-11 Online:2021-09-20 Published:2021-10-20

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摘要： 目的 介绍在虚拟手术计划辅助下行经口内入路下颌骨切除和血管化骨重建的经验,评价术后重建效果。方法 对9例下颌骨良性肿瘤患者术前行虚拟手术计划,设计、制作适用于口内操作的预设钉孔的导板。然后经口内入路利用截骨导板行下颌骨切除,预弯钛板及血管化骨瓣的植入和固定。术中实时导航验证新下颌骨的空间位置。术后半年,通过临床及影像学检查评价患者外形和功能;通过术后CT与术前STL模型拟合,评估下颌骨重建的精确性。采用SPSS 15.0软件包对数据进行统计学分析。结果 在虚拟手术计划辅助下,9例患者均顺利完成经口内入路下颌骨切除及血管化下颌骨重建,术中导航证实重建下颌骨位置准确。术后半年复查见患者面部对称,无面瘫及开口受限。患者对手术效果满意。图像拟合显示,截骨线位置精确,误差<1 mm[（0.72±0.15）mm],下颌骨重建位置与术前设计高度一致,误差为（1.76±1.99）mm。结论 在虚拟手术计划辅助下,利用预设钉孔的导板和预弯钛板,可以精确实施口内下颌骨切除及血管化骨重建,避免了口外切口,显著提高了下颌骨重建的精确性。

关键词: 口内入路, 截骨导板, 虚拟手术计划, 显微血管吻合, 下颌骨重建

Abstract: PURPOSE: This study was aimed to introduce the experience of mandibulectomy and vascularized bone reconstruction via intraoral approach assisted by virtual surgical plan and evaluate the effect of postoperative reconstruction. METHODS: Nine patients with benign tumor in the mandible underwent preoperative virtual surgical planning, then screw-predesignated osteotomy guide plate suitable for intraoral operation was designed and manufactured. Mandibulectomy was performed with cutting guide plate, prebent titanium plate and vascularized bone flap were implanted and fixed via intraoral approach. Intraoperative real-time navigation was used to confirm and correct the spatial location of the neo-mandible. The postoperative appearance and function of the patients were evaluated by clinical and imaging examination, and the accuracy of mandibular reconstruction was evaluated by superimposing postoperative CT on preoperative STL model after six months. SPSS 15.0 software package was used for statistical analysis. RESULTS: Aided with the virtual surgical plan, all patients in this series successfully underwent mandibulectomy and reconstruction with vascularized bone flap via intraoral approach. Intraoperative navigation confirmed the correct location of the reconstructed mandible. All patients showed facial symmetry, no facial paralysis and mouth opening limitation at 6-month postoperative visit were noted. All patients were satisfied with the results of the operation. Image fitting showed that the osteotomy line position was accurate with an error of less than 1 mm [(0.72±0.15)mm], and the reconstructed position of the mandible was highly consistent with preoperative design with an error of (1.76±1.99)mm. CONCLUSIONS: Under the guide of virtual surgical planning, intraoral mandibulectomy and vascularized bone reconstruction could be successfully performed by using screw-predesignated guide plate and prebent titanium plate, avoiding extraoral incision and significantly improving the accuracy of mandibular reconstruction.

Key words: Transoral approach, Cutting guide, Virtual surgical planning, Microvascular anastomosis, Mandibular reconstruction

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