腓骨肌皮瓣修复下颌骨节段性缺损术前有限元分析

doi:10.19438/j.cjoms.2021.04.007

中国口腔颌面外科杂志 ›› 2021, Vol. 19 ›› Issue (4): 325-331.doi: 10.19438/j.cjoms.2021.04.007

腓骨肌皮瓣修复下颌骨节段性缺损术前有限元分析

王义洲, 蔡嫚, 孙立凡, 祝庆海, 侯辰兴, 韩微, 汤雨婷, 孙楠楠, 王晨星, 李怀奇, 叶金海

南京医科大学口腔疾病研究江苏省重点实验室,南京医科大学附属口腔医院口腔颌面外科,江苏南京 210029

收稿日期:2021-02-18 修回日期:2021-05-20 出版日期:2021-07-20 发布日期:2021-08-05
通讯作者: 叶金海,E-mail: yjh98001@163.com
作者简介:王义洲(1994-),男,在读硕士研究生,E-mail: 756991473@qq.com
基金资助:
国家自然科学基金（81371123）; 江苏省高校优势学科建设工程资助项目（2018-87）; 江苏省“科教强卫工程”医学重点人才项目（ZDRCA2016087）; 东南大学-南京医科大学合作项目（JX105GSP2017DN03）

Preoperative finite element analysis of fibula myocutaneous flap for segmental mandibular reconstruction

WANG Yi-zhou, CAI Man, SUN Li-fan, ZHU Qing-hai, HOU Chen-xing, HAN Wei, TANG Yu-ting, SUN Nan-nan, WANG Chen-xing, LI Huai-qi, YE Jin-hai

Jiangsu Key Laboratory of Oral Diseases, Department of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital of Nanjing Medical University. Nanjing 210029, Jiangsu Province, China

Received:2021-02-18 Revised:2021-05-20 Online:2021-07-20 Published:2021-08-05

摘要/Abstract

摘要： 目的： 利用有限元分析方法,探讨血管化腓骨肌皮瓣修复重建下颌骨大范围节段性缺损术后下颌骨偏移的生物力学原因;并通过术后随访,验证分析其有效性,以获得一种能在术前对手术方案设计提供参考的研究方法。方法： 选择20例采用血管化腓骨肌皮瓣修复重建下颌骨肿瘤术后缺损的病例,其中10例采用传统手术方式,另10例采用改良数字化导板技术。对比分析2组患者术前、术后患侧关节间隙变化;再基于改良数字化术前三维手术方案,建立下颌骨重建术后的三维有限元分析模型,分析应变趋势;最后通过比较患者术前与术后6个月的锥形束CT（CBCT）数据,分析下颌骨偏移趋势。采用GraphPad Prism 8软件包对数据进行统计学分析。结果： 2组患者手术前、后健侧关节间隙变化值无显著差异,而与传统手术组病例相比,改良数字化技术组手术前、后患侧关节间隙变化值显著减小(P<0.05)。采用改良数字化技术设计的病例术前治疗方案,成功建立有限元分析模型,分析得出患侧（右侧）髁突在横断位上发生顺时针方向的旋转运动、在冠状位上髁突向内旋转、在矢状位上向后旋转,冠突向外向下移位。对比该患者术前与术后6个月的CBCT影像,下颌骨偏移趋势与术前进行的有限元分析结果吻合。结论： 有限元分析对采用改良数字化导板技术进行血管化腓骨瓣修复重建下颌骨缺损的病例,能定性分析下颌骨缺损重建术后颌骨偏移情况,并于术前对手术方案设计提供参考。

关键词: 下颌骨, 腓骨肌皮瓣, 数字化外科, 有限元分析

Abstract: PURPOSE: To explore the biomechanical reasons of mandible deviation after vascularized fibular myocutaneous flap repair and reconstruction of large-area segmental defect of mandible by using finite element static analysis method, and to verify the effectiveness of the analysis through postoperative follow-up, so as to obtain a research method that can provide reference for the design of operation plan before operation. METHODS: Ten cases of traditional surgery and 10 cases of digital technology for mandibular segmental resection and vascularized fibula reconstruction were included in this study. Based on a case of digital preoperative three-dimensional surgery, the three-dimensional finite element analysis model of mandible reconstruction was established to analyze the strain trend. Then cone-beam CT (CBCT) data of postoperative follow-up and preoperative CBCT data were compared. GraphPad Prism 8 software package was used for statistical analysis. RESULTS: There was no significant difference between the two groups before and after operation; but compared with the traditional group, the change of joint space of the affected side in the digital group was significantly reduced(P<0.05). Based on the preoperative operation plan of a case using digital technology, the finite element analysis model was successfully established, and the results showed that the condyle of the affected side (right side) rotated clockwise in the transverse position; the epicondyle rotated inward in the coronal position; the coronal process shifted outward and downward in the sagittal position. The CBCT images before and 6 months after operation were compared, and the jaw displacement trend was consistent with the findings of finite element analysis. CONCLUSIONS: Finite element analysis can qualitatively analyze the deviation of mandible after reconstruction of mandible defect with vascularized fibula flap using improved digital guide plate technology, and provide reference for the design of operation plan before operation.

Key words: Mandible, Fibular flap, Computer assist surgery, Finite element analysis

中图分类号:

R782.2

王义洲, 蔡嫚, 孙立凡, 祝庆海, 侯辰兴, 韩微, 汤雨婷, 孙楠楠, 王晨星, 李怀奇, 叶金海. 腓骨肌皮瓣修复下颌骨节段性缺损术前有限元分析[J]. 中国口腔颌面外科杂志, 2021, 19(4): 325-331.

WANG Yi-zhou, CAI Man, SUN Li-fan, ZHU Qing-hai, HOU Chen-xing, HAN Wei, TANG Yu-ting, SUN Nan-nan, WANG Chen-xing, LI Huai-qi, YE Jin-hai. Preoperative finite element analysis of fibula myocutaneous flap for segmental mandibular reconstruction[J]. China J Oral Maxillofac Surg, 2021, 19(4): 325-331.

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腓骨肌皮瓣修复下颌骨节段性缺损术前有限元分析

Preoperative finite element analysis of fibula myocutaneous flap for segmental mandibular reconstruction

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