摘要
目的探讨数字化技术在游离腓骨肌皮瓣修复重建下颌骨缺损中的临床效果。方法回顾分析2012年1月至2021年5月游离腓骨肌皮瓣修复重建下颌骨缺损患者45例。试验组27例,男性15例,女性12例,年龄14~76岁,中位年龄47岁,采用数字化外科(术前虚拟设计、3D打印、导板引导下手术)辅助手术;对照组18例,男性9例,女性9例,年龄21~69岁,中位年龄39岁,采用传统方法(依靠术者经验切除下颌骨、牙弓夹板指导腓骨瓣塑形)完成手术。比较2组手术时间、出血量、咬合关系、最大开口度、面部外形视觉模拟评分(VAS)及华盛顿大学生活质量调查问卷评分;髁突位置偏移、下颌角点位置偏移、下颌角角度变化及下颌角宽度变化等。结果全部病例均顺利完成手术,2组在手术时间、出血量比较差异均有统计学意义(P<0.05);试验组手术前后最大张口度比较差异有统计学意义(P<0.05),对照组差异无统计学意义(P>0.05),试验组术前最大张口度小于对照组,差别有统计学意义(P<0.05);试验组面部VAS分级优48.1%,良21.9%,无差,优于对照组;试验组华盛顿质量生活问卷得分(1061±136)分,对照组(755±142)分,2组比较差异均有统计学意义(P<0.05)。试验组髁突位置偏移,小于对照组;试验组中位下颌角位置偏移,小于对照组1;试验组中位下颌角角度偏差小于对照组;试验组中位下颌角宽度偏差小于对照组,比较差异均有统计学意义(P<0.05)。结论相较传统手术,数字化技术辅助游离腓骨肌皮瓣修复下颌骨缺损,不仅可有效缩短手术时间、减少出血量,改善张口度,避免咬合紊乱,恢复面部外形,提高生活质量,而且更有助于提高下颌骨缺损修复重建的精确性和稳定性。
Objective To determine the curative effects of digital technology in the repair and reconstruction of mandible defect with free fibular flap.Methods The clinical data of 45 patients,who underwent repair and reconstruction of mandible defect with free fibular flap between January 2012 and May2021,were retrospectively analyzed.The study group,consisting of 27 patients(15 males and 12 females),aged14-76 years old with a median age of 47 years old,was treated under the assistance of digital surgical technology(preoperative virtual design,3D printing,guide plate guided surgery).The control group consisting of 18 patients(9 males and 9 females),aged 21-69 years old with a median age of 39 years old,was treated by conventional surgery(simply per expertise of the proceduralists).The operation time,blood loss,occlusal relationship,maximum mouth opening,VAS score of facial appearance and University of Washington Quality of Life Questionnaire(UW-QOL)score were compared between the two groups.The changes in the condyle position deviation,mandibular angle position deviation,mandibular angle angular variation and mandibular angle width were compared between the two groups.P<0.05 was considered statistical significant.Results All patients underwent the operation uneventfully.There were statistical differences in median operation time and median blood loss between the two groups(both P<0.05).There was statistical difference in the median maximum mouth opening at baseline and after the operation in the study group(P<0.05).There was no statistical difference in the median maximum mouth opening at baseline and after the operation in the control group(P>0.05).The preoperative median maximum mouth opening in the study group was less than that in the control group,with statistically significant difference between the two groups(P<0.05).The postoperative median mouth opening in the study group was less than that in the control group,but the difference was not statistically significant(P>0.05).The facial VAS classification in the study group was 48.1%excellent,21.9%good and 0.0%poor.There was statistical difference in the mean score of UW-QOL between the study group and control group(1060±136 vs 755±142,P<0.05).The median condyle position deviation,mandibular angle position deviation,mandibular angle angular deviation(4.030 mm vs8.690 mm)and mandibular angle width deviation in the study group were all less than those in the control group,with statistical differences(all P<0.05).Conclusion Compared with conventional surgery,digital technology assisted free fibular flap for mandibular defect repair may effectively shorten the operation time,reduce blood loss,improve mouth opening,avoid occlusal disorder,restore facial appearance,improve the quality of life,and may contribute more to an accurate and stable repair and reconstruction of mandible defect.
作者
张新华
吴婷婷
章文博
侯伟
马雪芳
柳新华
彭歆
Zhang Xinhua;Wu Tingting;Zhang Wenbo;Hou Wei;Ma Xuefang;Liu Xinhua;Peng Xin(Department of Stomatology,Jinzhong First Municipal People′s Hospital,Shanxi 030600,China;Department of Oral and Maxillofacial Surgery,School of Stomatology,Peking University,Beijing 100081,China)
出处
《中国药物与临床》
CAS
2022年第4期303-308,共6页
Chinese Remedies & Clinics
基金
山西省晋中市科技计划项目(Y193006)。
关键词
腓骨
下颌骨重建术
导板
数字化技术
评价
Fibula
Mandibular reconstruction
Guide plate
Digital surgical technology
Evaluation
