游离腓骨瓣重建上颌骨半侧缺损数字化模拟和辅助设计
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摘要
目的术前模拟游离腓骨瓣重建上颌骨半侧缺损,快速生成个性化重建辅助方案,并分析其可行性。方法以1名健康男性志愿者的薄层CT为源数据样本,利用Mimics软件建立游离腓骨瓣重建上颌骨半侧缺损的三维模型,对不同分段设计的腓骨重建上颌骨半侧缺损进行术前模拟和分析;利用3-matic软件包设计生成个性化重建板,并且模拟最终修复。结果本研究精确建立了3种(2段式、3段式和4段式)游离腓骨重建上颌骨半侧缺损模型,其所需腓骨的总长度分别约为6 mm、8 mm以及12 mm;并且本研究快速设计了个性化重建板以及模拟了后期种植修复。结论数字化模拟可以快速地建立游离腓骨重建上颌骨半侧缺损的可视化方案,为进一步精确辅助术者设计生成重建板和定位导板奠定基础。
Objective To analyze the feasibility of digitally simulating the maxillary unilateral defect reconstructed by free fibula flap.Methods A thin slice CT of a healthy male volunteer was used as the data source in this study. The 3 D models for reconstruction of unilateral maxillary defect by three kinds of designed segments of fibula( 2-segment,3-segment and 4-segment) were established. And feasibilities of three reconstrucive stratgeries were analyzed properatively. Futhermore,customized plates,implants,zygomatic implants and upper structures of the three stratgeries were simulated. Results In this study reconstructions by 2-segment,3-segment and 4-segment fibula flap were simulated accurately and the length of fibula for reconstruction was 6 mm,8 mm and 12 mm respectively. Moreover,customized plates,dental implants,upper structure were simulated preoperativly and rapidly. Conclusion Visual strategeries of maxillary reconstruction by free fibula flap can be established rapidly via digital simulation preoperatively and individually,and it supply data fundation for further digital subsidiary steps.
Objective To analyze the feasibility of digitally simulating the maxillary unilateral defect reconstructed by free fibula flap.Methods A thin slice CT of a healthy male volunteer was used as the data source in this study. The 3 D models for reconstruction of unilateral maxillary defect by three kinds of designed segments of fibula( 2-segment,3-segment and 4-segment) were established. And feasibilities of three reconstrucive stratgeries were analyzed properatively. Futhermore,customized plates,implants,zygomatic implants and upper structures of the three stratgeries were simulated. Results In this study reconstructions by 2-segment,3-segment and 4-segment fibula flap were simulated accurately and the length of fibula for reconstruction was 6 mm,8 mm and 12 mm respectively. Moreover,customized plates,dental implants,upper structure were simulated preoperativly and rapidly. Conclusion Visual strategeries of maxillary reconstruction by free fibula flap can be established rapidly via digital simulation preoperatively and individually,and it supply data fundation for further digital subsidiary steps.
引文
[1]张志愿,竺涵光,郑家伟,等.腓骨游离组织瓣在口腔颌面外科的应用[J].口腔颌面外科杂志,1999,9(1):42-46.
[2] Lenoxn D,Kim DD. Maxillary reconstruction[J]. Oral Maxil Surg Clin,2013,25(2):215-220.
[3] Naohiro I,Yusuke S,Jyun I,et al. Analysis of fibular single graft and fibular double-barrel graft for mandibular reconstruction[J]. Plast Reconstr Surg Global Open,2016,4(8):1-9.
[4] Baj A,Youssef DA,Monteverdi R,et al. Reconstruction of partial maxillary defects with the double-barrel fibula free flap[J].Acta Otorhinolaryngol,2010,30(6):299-302.
[5] Lee YW,You HJ,Jung JA,et al. Mandibular reconstruction using customized three-dimensional titanium implant[J]. Arch Craniofac Surg,2018,19(2):152-156.
[6] Chang YM,Tsai CY,Wei FC. One-stage,double-barrel fibula osteoseptocutaneous flap and immediate dental implants for functional and aesthetic reconstruction of segmental mandibular defects[J]. Plast Reconstr Surg,2008,122(1):143-145.
[7] Liu XJ,Gui L,Mao C,et al. Applying computer techniques in maxillofacial reconstruction using a fibula flap:a messenger and an evaluation method[J]. J Craniofac Surg,2009,20(2):372-377.
[8]谭培勇,陈尽欢,李鹏,等.下颌骨CT三维重建中阈值分割的改进及应用[J].四川大学学报(医学版),2015,46(3):458-462.
[9] Brown JS,Shaw RJ. Reconstruction of the maxilla and midface:introducing a new classification[J]. Lancet Oncol,2010,11(10):1001-1008.
[10] Hidalgo DA. Fibula free flap:a new method of mandible reconstruction[J]. Plast Reconstr Surg,1989,84(1):71-79.
[11] Sadove RC,Powell LA. Simultaneous maxillary and mandibular reconstruction with one free osteocutaneous flap[J]. Plast Reconstr Surg,1993,92(1):141-146.
[12] Schusterman MA,Reece GP,Miller MJ. Osseous free flaps for orbit and midface reconstruction[J]. Am J Surg,1993,166(4):341-345.
[13]孙坚,李军,张志愿,等.上颌骨大型缺损的个体化三维闭合式功能性重建[J].中国口腔颌面外科杂志,2003,3(1):3-7.
[14] Lethaus B,Kessler P,Boeckman R,et al. Reconstruction of a maxillary defect with a fibula graft and titanium mesh using CAD/CAM techniques[J]. Head Face Med,2010,6:16.
[15] Sun J,Shen Y,Li J,et al. Reconstruction of high maxillectomy defects with the fibula osteomyocutaneous flap in combination with titanium mesh or a zygomatic implant[J]. Plast Reconstr Surg,2011,127(1):150-160.
[16] Wang YY,Fan S,Zhang HQ,et al. Virtual Surgical Planning in Precise Maxillary Reconstruction With Vascularized Fibular Graft After Tumor Ablation[J]. J Oral Maxillofac Surg,74(6):1255-1264.
[17] Jostrom M,Sennerby L,Nilson H,et al. Reconstruction of the atrophic edentulous maxilla with free iliac crest grafts and implants:a 3-year report of a prospective clinical study[J]. Clin Implant Dent Relat Res,2007,9(1):46-59.
[18] Jacobsen C,Kruse A,Lübbers HT,et al. Is mandibular reconstruction using vascularized fibula flaps and dental implants a reasonable treatment[J]. Clin Implant Dent R,2014,16(3):419-428.
[19] Wong RCW,Tideman H,Merkx MAW,et al. Review of biomechanical models used in studying the biomechanics of reconstructed mandibles[J]. Int J Oral Max Impl,2011,40(4):393-400.
[20] Ihde S,Kopp S,Gundlach K,et al. Effects of radiation therapy on craniofacial and dental implants:a review of the literature[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol,2009,107(1):56-65.
[21] Daya M. Peroneal artery perforator chimeric flap:changing the perspective in free fibula flap use in complex oromandibular reconstruction[J]. J Reconstr Microsurg,2008,24(6):413-418.
[22]竺涵光,马玉中.腓骨游离瓣重建下颌骨的骨段塑形与固定方法[J].口腔颌面外科杂志,1999,9(1):46-50.
[23]李劲松,潘朝斌,王建广,等.改良游离腓骨瓣塑形方法修复双侧下颌骨缺损[J].中山大学学报(医学科学版),2004,25(2):171-173.
[24] Nkenke E,Eitner S. Complex hemimaxillary rehabilitation with a prefabricated fibula flap and cast-based vacuum-formed surgical template[J]. J Prosthet Dent,2014,111(6):521-524.
[25] Fu K,Liu Y,Gao N,et al. Reconstruction of maxillary and orbital floor defect with free fibula flap and whole individualized titanium mesh assisted by computer techniques[J]. J Oral Maxillofac Surg,2017,75(8):1791e1-e9.
[26] Morita D,Numajiri T,Nakamura H,et al. Intraoperative change in defect size during maxillary reconstruction using surgical guides created by CAD/CAM[J]. Plast Reconstr Surg Glob Open,2017,5(4):1-4.
[27] Frank W,Carl-Peter C,Alexander S. Computer-assisted mandibular reconstruction using a patient-specific reconstruction plate fabricated with computer-aided design and manufacturing techniques[J]. Craniomaxillofac Trauma Reconstr,2014,7(7):158-166.
[2] Lenoxn D,Kim DD. Maxillary reconstruction[J]. Oral Maxil Surg Clin,2013,25(2):215-220.
[3] Naohiro I,Yusuke S,Jyun I,et al. Analysis of fibular single graft and fibular double-barrel graft for mandibular reconstruction[J]. Plast Reconstr Surg Global Open,2016,4(8):1-9.
[4] Baj A,Youssef DA,Monteverdi R,et al. Reconstruction of partial maxillary defects with the double-barrel fibula free flap[J].Acta Otorhinolaryngol,2010,30(6):299-302.
[5] Lee YW,You HJ,Jung JA,et al. Mandibular reconstruction using customized three-dimensional titanium implant[J]. Arch Craniofac Surg,2018,19(2):152-156.
[6] Chang YM,Tsai CY,Wei FC. One-stage,double-barrel fibula osteoseptocutaneous flap and immediate dental implants for functional and aesthetic reconstruction of segmental mandibular defects[J]. Plast Reconstr Surg,2008,122(1):143-145.
[7] Liu XJ,Gui L,Mao C,et al. Applying computer techniques in maxillofacial reconstruction using a fibula flap:a messenger and an evaluation method[J]. J Craniofac Surg,2009,20(2):372-377.
[8]谭培勇,陈尽欢,李鹏,等.下颌骨CT三维重建中阈值分割的改进及应用[J].四川大学学报(医学版),2015,46(3):458-462.
[9] Brown JS,Shaw RJ. Reconstruction of the maxilla and midface:introducing a new classification[J]. Lancet Oncol,2010,11(10):1001-1008.
[10] Hidalgo DA. Fibula free flap:a new method of mandible reconstruction[J]. Plast Reconstr Surg,1989,84(1):71-79.
[11] Sadove RC,Powell LA. Simultaneous maxillary and mandibular reconstruction with one free osteocutaneous flap[J]. Plast Reconstr Surg,1993,92(1):141-146.
[12] Schusterman MA,Reece GP,Miller MJ. Osseous free flaps for orbit and midface reconstruction[J]. Am J Surg,1993,166(4):341-345.
[13]孙坚,李军,张志愿,等.上颌骨大型缺损的个体化三维闭合式功能性重建[J].中国口腔颌面外科杂志,2003,3(1):3-7.
[14] Lethaus B,Kessler P,Boeckman R,et al. Reconstruction of a maxillary defect with a fibula graft and titanium mesh using CAD/CAM techniques[J]. Head Face Med,2010,6:16.
[15] Sun J,Shen Y,Li J,et al. Reconstruction of high maxillectomy defects with the fibula osteomyocutaneous flap in combination with titanium mesh or a zygomatic implant[J]. Plast Reconstr Surg,2011,127(1):150-160.
[16] Wang YY,Fan S,Zhang HQ,et al. Virtual Surgical Planning in Precise Maxillary Reconstruction With Vascularized Fibular Graft After Tumor Ablation[J]. J Oral Maxillofac Surg,74(6):1255-1264.
[17] Jostrom M,Sennerby L,Nilson H,et al. Reconstruction of the atrophic edentulous maxilla with free iliac crest grafts and implants:a 3-year report of a prospective clinical study[J]. Clin Implant Dent Relat Res,2007,9(1):46-59.
[18] Jacobsen C,Kruse A,Lübbers HT,et al. Is mandibular reconstruction using vascularized fibula flaps and dental implants a reasonable treatment[J]. Clin Implant Dent R,2014,16(3):419-428.
[19] Wong RCW,Tideman H,Merkx MAW,et al. Review of biomechanical models used in studying the biomechanics of reconstructed mandibles[J]. Int J Oral Max Impl,2011,40(4):393-400.
[20] Ihde S,Kopp S,Gundlach K,et al. Effects of radiation therapy on craniofacial and dental implants:a review of the literature[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol,2009,107(1):56-65.
[21] Daya M. Peroneal artery perforator chimeric flap:changing the perspective in free fibula flap use in complex oromandibular reconstruction[J]. J Reconstr Microsurg,2008,24(6):413-418.
[22]竺涵光,马玉中.腓骨游离瓣重建下颌骨的骨段塑形与固定方法[J].口腔颌面外科杂志,1999,9(1):46-50.
[23]李劲松,潘朝斌,王建广,等.改良游离腓骨瓣塑形方法修复双侧下颌骨缺损[J].中山大学学报(医学科学版),2004,25(2):171-173.
[24] Nkenke E,Eitner S. Complex hemimaxillary rehabilitation with a prefabricated fibula flap and cast-based vacuum-formed surgical template[J]. J Prosthet Dent,2014,111(6):521-524.
[25] Fu K,Liu Y,Gao N,et al. Reconstruction of maxillary and orbital floor defect with free fibula flap and whole individualized titanium mesh assisted by computer techniques[J]. J Oral Maxillofac Surg,2017,75(8):1791e1-e9.
[26] Morita D,Numajiri T,Nakamura H,et al. Intraoperative change in defect size during maxillary reconstruction using surgical guides created by CAD/CAM[J]. Plast Reconstr Surg Glob Open,2017,5(4):1-4.
[27] Frank W,Carl-Peter C,Alexander S. Computer-assisted mandibular reconstruction using a patient-specific reconstruction plate fabricated with computer-aided design and manufacturing techniques[J]. Craniomaxillofac Trauma Reconstr,2014,7(7):158-166.