计算机辅助技术在肋骨软骨移植重建颞下颌关节中的应用

doi:10.19438/j.cjoms.2017.03.011

中国口腔颌面外科杂志 ›› 2017, Vol. 15 ›› Issue (3): 245-248.doi: 10.19438/j.cjoms.2017.03.011

计算机辅助技术在肋骨软骨移植重建颞下颌关节中的应用

甄锦泽#，钟晓琪#，张善勇*，郑吉驷*，孙守福，李慧萍

上海交通大学医学院附属第九人民医院·口腔医学院口腔外科，上海市口腔医学重点实验室，上海 200011

收稿日期:2016-10-08 修回日期:2017-02-14 出版日期:2017-05-20 发布日期:2017-06-09
通讯作者: 国家自然科学基金（81371168）；上海交通大学医工交叉项目（YG2013MS63）；上海市教育委员会高峰-高原学科-上海交通大学医学院“研究型医师”（20152226）；上海交通大学医学院转化医学创新基金（15ZH2007）
作者简介:甄锦泽（1990-），男，硕士，住院医师，E-mail: zhenlich@163.com；钟晓琪（1993-），男，硕士，E-mail：229400655@qq.com。#并列第一作者
基金资助:
张善勇，E-mail: zhangshanyong@126.com；郑吉驷, E-mail:237111641@qq.com。*共同通信作者

Computer-assisted surgical simulation for temporomandibular joint reconstruction with costochondral graft

ZHEN Jin-ze, ZHONG Xiao-qi, ZHANG Shan-yong, ZHENG Ji-si, SUN Shou-fu, LI Hui-ping.

Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine；
Shanghai Key Laboratory of Stomatology. Shanghai 200011, China

Received:2016-10-08 Revised:2017-02-14 Online:2017-05-20 Published:2017-06-09

摘要/Abstract

摘要： 目的：评价计算机辅助技术（computer-assisted surgical simulation, CASS）在肋骨软骨移植（costochondral graft，CCG）重建颞下颌关节中的应用效果。方法：选取2013年11月—2015年3月进行CCG的患者。术前通过拍摄颅颌面CT和胸部CT，将其导入到Mimics软件，进行虚拟定位和规划截骨，用于指导软骨的选择和放置以及手术过程中髁突和下颌支的修整。术后应用Mimics软件测量和计算肋骨移植的偏差。结果：7例（9侧）利用CASS进行CCG的患者被纳入研究，其中男2例，女5例；平均年龄30.2岁（21~45岁）。单侧5例，双侧2例。7侧关节重建选择第6肋骨，2侧关节重建选择第7肋骨。所有置换肋骨在手术中均未进行修整或弯曲。术后CT扫描显示所有患者通过CASS进行CCG，成功重建了下颌髁突。所有患者的肋骨-肋软骨均恰好位于关节窝内，咬合关系良好，无需颌间牵引。共植入46颗钛钉，均位于下牙槽神经血管束后。16颗钛钉在下颌支内侧面暴露,平均暴露长度为0.7 mm（0.2~1.3 mm）。合并后的CT表明，与术前设计的位置相比，CCG的末端相对倾斜且靠前，倾斜度的平均值为5.4° (1.7~7.3°)。结论：CASS能够精确选择合适的肋骨，匹配下颌支的外侧面，引导截骨和修整，帮助肋骨固定在预期位置，避免对下牙槽神经血管束的损伤。

关键词: 颞下颌关节, 肋骨软骨移植, 计算机辅助手术模拟

Abstract: PURPOSE: This study was to introduce the application of computer-assisted surgical simulation (CASS) for temporomandibular joint (TMJ) reconstruction with costochondral graft (CCG). METHODS: Patients who underwent TMJ reconstruction with CCG from November 2013 to March 2015 were included in this study. Cranio-maxillofacial and chest CT scans were performed and imported into the Mimics software for virtual positioning and osteotomy planning to guide the selection and placement of the rib and bone trimming of the condyle and ramus before surgery. The implanted deviation of the rib was measured or calculated in Mimics software. RESULTS: Seven patients (9 joints) who underwent CCG utilizing CASS were included. There were 5 females and 2 males with a mean age of 30.2 years (range, 21 to 45 years). There were 5 patients with unilateral joints reconstruction and 2 patients with bilateral joints reconstruction. In 7 joint reconstructions, the 6th rib was selected, while the 7th rib was selected in 2 joints. All the grafted ribs were not trimmed or contoured intraoperatively. Postoperative CT scans indicated that all patients had successful reconstruction of the mandibular condyle with CCG using CASS. 46 titanium screws in total were implanted and located behind the inferior alveolar neurovascular bundle. There were 16 titanium screws protruding from the medial surface of the ramus, and the mean exposed length was 0.7 mm (range, 0.2 to 1.3 mm). The merged CT scans indicated that the distal end of the CCG was implanted obliquely and anteriorly compared with the predesigned positions, and the mean deviated degree was 5.4°(range, 1.7 to 7.3°). CONCLUSIONS: CASS is an accurate method to select a suitable rib (usually the 6th and 7th) matching with the TMJ anatomy and avoid the blindness of CCG.

Key words: Temporomandibular joint, Costochondral graft, Computer-assisted surgical simulation

中图分类号:

R782.6

甄锦泽#，钟晓琪#，张善勇*，郑吉驷*，孙守福，李慧萍. 计算机辅助技术在肋骨软骨移植重建颞下颌关节中的应用[J]. 中国口腔颌面外科杂志, 2017, 15(3): 245-248.

ZHEN Jin-ze, ZHONG Xiao-qi, ZHANG Shan-yong, ZHENG Ji-si, SUN Shou-fu, LI Hui-ping.. Computer-assisted surgical simulation for temporomandibular joint reconstruction with costochondral graft[J]. China J Oral Maxillofac Surg, 2017, 15(3): 245-248.

参考文献

[1] Zhang S, Liu X, Xu Y, et al. Application of rapid prototyping for temporomandibular joint reconstruction [J]. J Oral Maxillofac Surg, 2011, 69(2): 432-438.
[2] Saeed NR, Kent JN. A retrospective study of the costochondral graft in TMJ reconstruction [J]. Int J Oral Maxillofac Surg, 2003, 32(6): 606-609.
[3] Cope MR, Moos KF, Hammersley N. The compressible silicone rubber prosthesis in temporomandibular joint disease [J]. Br J Oral Maxillofac Surg, 1993, 31(6): 376-384.
[4] Figueroa AA, Gans BJ, Pruzansky S. Long-term follow-up of a mandibular costochondral graft [J]. Oral Surg Oral Med Oral Pathol, 1984, 58(3): 257-268.
[5] MacIntosh RB, Henny FA. A spectrum of application of autogenous costochondral grafts [J]. J Oral Maxillofac Surg, 1977, 5(4): 257-267.
[6] Link JO, Hoffman DC, Laskin DM. Hyperplasia of a costochondral graft in an adult [J]. J Oral Maxillofac Surg, 1993, 51(12): 1392-1394.
[7] Papadopoulos MA, Christou PK, Christou PK, et al. Three-dimensional craniofacial reconstruction imaging [J]. Oral Surg Oral Med O, 2002, 93(4): 382-393.
[8] Xia J, Ip HH, Samman N, et al. Computer-assisted three-dimensional surgical planning and simulation: 3D virtual osteotomy [J]. Int J Oral Maxillofac Surg, 2000, 29(1): 11-17.
[9] Bai G, He D, Yang C, et al. Application of digital templates to guide total alloplastic joint replacement surgery with biomet standard replacement system [J]. J Oral Maxillofac Surg, 2014, 72(12): 2440-2452.
[10] Lu C, Huang D, He D, et al. Digital occlusal splint for condylar reconstruction in children with temporomandibular joint ankylosis [J]. J Oral Maxillofac Surg, 2014, 72(8): 1585-1593.
[11] Qiu Y, Yang C, Chen M. Endoscopically assisted reconstruction of the mandibular condyle with a costochondral graft through a modified preauricular approach[J]. Br J Oral Maxillofac Surg, 2010, 48(6): 443-447.
[12] Rotaru H, Stan H, Florian IS, et al. Cranioplasty with custom-made implants: analyzing the cases of 10 patients [J]. J Oral Maxillofac Surg, 2012, 70(2): e169-e176.
[13] Gateno J, Xia JJ, Teichgraeber JF, et al. Clinical feasibility of computer-aided surgical simulation (CASS) in the treatment of complex cranio-maxillofacial deformities[J]. J Oral Maxillofac Surg, 2007, 65(4): 728-734.
[14] Movahed R, Teschke M, Wolford LM. Protocol for concomitant temporomandibular joint custom-fitted total joint reconstruction and orthognathic surgery utilizing computer-assisted surgical simulation [J]. J Oral Maxillofac Surg, 2013, 71(12): 2123-2129.
[15] Zhang W, Gu B, Hu J, et al. Retrospective comparison of autogenous costochondral graft and coronoid process graft in the management of unilateral ankylosis of the temporomandibular joint in adults [J]. Br J Oral Maxillofac Surg, 2014, 52(10): 928-933.
[16] El-Sayed KM. Temporomandibular joint reconstruction with costochondral graft using modified approach[J]. Int J Oral Maxillofac Surg, 2008, 37(10): 897-902.

计算机辅助技术在肋骨软骨移植重建颞下颌关节中的应用

Computer-assisted surgical simulation for temporomandibular joint reconstruction with costochondral graft

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