CAD/CAM技术在游离腓骨瓣移植重建下颌骨中的应用

目的:探讨在游离腓骨瓣移植重建下颌骨中应用CAD/CAM技术的方法,并尝试将计算机中的辅助设计准确的转化为手术中的实际操作.方法:为8 位下颌骨缺损患者进行了CAD/CAM血管化游离腓骨瓣移植修复,通过螺旋CT扫描获取缺损区及腓骨的数据,在软件中进行缺损区修复的模拟设计,在此基础上完成手术辅助导板的设计,利用快速成型机加工制作出导板实物,利用导板顺利的完成手术.结果:术中移植腓骨截取长度合适,截骨、塑形、定位速度明显加快,术后患者面部外形两侧对称,影像学检查显示下颌骨缺损区域的重建形态及固位良好.结论:游离腓骨瓣移植修复下颌骨缺损中应用CAD/CAM技术,能够降低手术难度,缩短手术时间,提高手术质量,保证手术效果.     

游离腓骨瓣在口腔下颌骨功能性重建中的应用

游离腓骨骨皮瓣 (Ｆｉｂｕｌａｏｓｔｅｏｃｕｔａｎｅｏｕｓｆｒｅｅｆｌａｐ ,ＦＯＦＦ) [1～ 4 ] 日益在临床的应用广泛。 1989年 ,Ｈｉｄａｌｇｏ[5] 首次报告利用ＦＯＦＦ修复口腔下颌骨缺损 ,全部 12例ＦＯＦＦ的腓骨均获得成活 ,以后 ,相继有牙种植体应用于ＦＯＦＦ恢复咀嚼功能的报道[6,7] 。 1992年 ,Ｈａｙｄｅｎ[1] 介绍了ＦＯＦＦ皮岛的神经支配 ,使其成为一具有神经感觉功能的复合瓣。本文结合作者完成 2 5例ＦＯＦＦ的临床体会 ,对此复合瓣的解剖、制备和优缺点作一简介。一、ＦＯＦＦ的血管解剖[1,2 ]月国动脉在月国肌下缘处…     

腓骨瓣修复下颌骨缺损的进展

腓骨瓣是下颌骨缺损重建的首选复合瓣之一,它可修复各种下颌骨复合缺损。本文综述了腓骨瓣的应用解剖、临床应用、供区并发症及骨融合种植体和牵引成骨技术在腓骨瓣的应用,表明了腓骨瓣在下颌骨缺损功能重建中的优越性。     

腓骨瓣修复下颌骨缺损的进展

腓骨瓣是下颌同缺损重建的首选复合瓣之一,它可修复各种颌同复合缺损,本文综述了腓骨瓣的应用解剖,临床应用,供区并发症及骨融合种植体和牵引成骨技术在腌骨瓣的应用,表明了腓骨瓣在下颌骨缺损功能重建中的优越性。     

3D打印技术在血管化腓骨瓣重建下颌骨大型缺损中的应用

目的 :比较3D打印技术与基于经验的传统方法 ,应用于血管化腓骨重建大型下颌骨缺损的临床效果,探讨前者在下颌骨重建中的价值。方法:回顾分析2011—2015间完成的15例血管化腓骨重建下颌骨的临床资料。按照下颌骨截骨与腓骨瓣制备中是否采用3D打印模型指导,分为2组:传统方法组9例(2011—2014年度病例),3D打印技术组6例(2014—2015年度病例)。主要分析一般资料特点,对照2组病例手术相关指标和术后效果评估情况。结果:与传统方法组相比,3D打印技术指导下手术,腓骨离体缺血时间少,修改次数少,骨断端接触面积大,手术前后下颌角的角度差异更小,颌骨外形更加满意;但在患者年龄、手术时间、住院天数、成功率等方面两组间差异无统计学意义。结论:3D打印技术的应用缩短了腓骨缺血时间,提高了截骨及颌骨形态精确度,优化了手术治疗效果。     

腓骨游离瓣重建下颌骨缺损的应用进展

腓骨游离瓣是重建大型下颌骨缺损的有效方法之一。它可提供约２５ｃｍ长的腓骨修复各种类型的大型下颌骨缺损；可携带皮岛修复口腔粘膜及面部皮肤缺损；血管口径大，蒂长，易于与颈部血管吻合。骨结合种植体及神经皮瓣的联合应用可使口腔功能进一步改善。     

CAD/CAM联合游离腓骨肌皮瓣修复双侧下颌骨大范围骨缺损

目的:探讨恢复双侧下颌骨大范围骨缺损的解剖外形、重建患者咬合功能的有效方法。方法:对病变累及双侧下颌骨、需进行(或已进行)节段性骨切除术的15例患者行术前CT扫描,提取扫描数据,采用CAD/CAM快速原型技术行数字化颅颌面骨三维重建和下颌骨实体模型打印。在实体模型上设计截骨区间和钛网外形,数控成型机冲压钛网,使预成钛网与缺损区下颌骨外形完全一致。切取腓骨肌皮瓣,血管化游离移植联合预成钛网植入完成下颌骨缺损的修复重建。结果:15例患者腓骨肌皮瓣全部存活,创口愈合良好,下颌骨解剖外形包括自然弧度、曲率和高度恢复满意,同期修复者手术前后容貌无明显变化。结论:CAD/CAM快速原型技术联合游离腓骨肌皮瓣移植修复双侧下颌骨大范围节段性骨缺损,不仅可以最大限度地重建下颌骨的自然外形,维持患者容貌,也为种植体植入及咬合功能重建创造了良好条件。     

游离腓骨复合瓣重建下颌骨缺损的临床研究

目的：探讨腓骨复合瓣重建下颌骨缺损时骨块的塑形、定位和固定方法。方法：15例患者根据下颌骨六种缺损类型，对腓骨进行截骨塑形，按定位钢板定位后的下颌骨缺损形态和长度准确就位，小钛板或重建板进行坚固定内固定。结果：15例腓骨复合瓣重建下颌骨缺损全部获得成功。腓骨截成二段者8例，三段者3例，4例未截断。术后面部外形恢复满意者13例，咬合关系正常者12例，张口度正常者14例，3例患者术后接受活动义齿修复，1例种植义齿修复并获得良好的咀嚼功能。结论：腓骨复合瓣可根据下颌骨缺损的部位和形态进行截断塑形，定位钢板能保证移植骨块的准确就位，根据应力分布原理进行坚固内固定可保证移植骨块的良好稳定性。     

运用腓骨组织瓣修复下颌骨缺损

对6 例患者用腓骨瓣游离移植修复下颌骨缺损.手术采取血管吻合、坚固内固定方法恢复下颌骨形态及完整性.其中3 例患者为单纯腓骨瓣移植, 3 例患者为携带肌皮瓣或皮瓣的腓骨瓣移植.6 例患者平均随访6 月～2 年,成功率为100%.4 例患者可正常进食, 2 例患者可进软食.5/6的患者面部外形的恢复达满意或较为满意.所有患者均能正常行走,无1 例出现踝关节不稳定.带血管蒂的游离腓骨组织瓣具有其它自体骨组织瓣不可比拟的优点,是下颌骨缺损修复重建的最佳方法之一.     

三维模拟技术在游离腓骨瓣移植重建下颌骨缺损中的应用

目的探讨在游离腓骨肌瓣移植修复下颌骨缺损过程中应用三维模拟技术（CAD/CAM）的方法。方法对11例患者（成釉细胞瘤8例,骨化性纤维瘤1例,下颌牙龈癌2例）术前应用三维模拟技术进行模拟手术,利用快速成型机制作出与患者下颌骨实际大小和外形完全一致的实体模型和手术辅助导板,在模拟修复完成的下颌骨模型上预成形重建钛板。手术中,一组根据术前设计的截骨方案切除病变下颌骨;另一组利用辅助导板在不断蒂状态下对腓骨进行精确的分段截骨,将截开的腓骨段准确塑形后,用预成形重建钛板加以固定,待受区准备完成后断蒂移植。结果11例患者移植的腓骨肌（皮）瓣均存活,术中移植腓骨所截取的长度合适,截骨、塑形、定位速度明显加快。术后随访1~24个月,影像学检查显示患者下颌骨重建形态及固位良好,颞下颌关节就位准确,口内检查剩余牙列咬合关系恢复正常。结论在游离腓骨肌（皮）瓣移植修复下颌骨缺损中应用三维模拟技术,不仅能够降低手术难度与风险,节省手术时间,还可提高手术质量,保证手术效果。     

Virtual planning,simultaneous dental implantation and CAD/CAM plate fixation: a paradigm change in maxillofacial reconstruction

Prosthetic rehabilitation in patients undergoing reconstructive surgery using vascularized free flaps is challenging, and functional rehabilitation of the patient with a fixed prosthesis is rare. Virtually planned maxillofacial reconstruction including simultaneous dental implantation according to the prosthodontic ideal position of the implants could further enhance dental rehabilitation. The data of 21 patients undergoing fibula free flap reconstructive surgery with CAD/CAM patient-specific reconstruction plates during the years 2015–2018 were analysed, including the applicability of the virtual plan, flap survival, duration of surgery, ischemia time, simultaneous dental implantation, implant exposure, and postoperative complications. The virtual plan could be translated to surgery in all cases. In total, 76 dental implants were simultaneously placed during primary reconstruction in the 21 patients. For 38.1% of these patients, the implants could be uncovered in secondary surgery; the mean duration until exposure was 7.6 months. The implant survival rate was 97.4% (74/76). Wound infection requiring a secondary intervention occurred in 23.8% of patients during follow-up. Virtually planned reconstruction with a fibula free flap, simultaneous dental implantation, and CAD/CAM plates allows early and functional dental rehabilitation. A dental workflow should be integrated into the virtual planning, and prosthetically favourable implant positions should determine the position of the fibula segments.     

The radial forearm flap as a carrier for the osteocutaneous fibula graft in mandibular reconstruction

According to the concept of a free flap carrier we transferred an osteocutaneous fibula graft after microanastomosis to a pedicled radial forearm flap for reconstruction of the lower face in a patient with a total occlusion of the left and a subtotal occlusion of the right common carotid artery. The fibula was osteotomized in three segments to form the new mandible, and the skin paddle was placed extraorally. An external fixation device was connected to the radial bone, and a halo frame was fixed to the skull, and the forearm was thus stabilized rigidly in a suitable position. After 2 weeks, serial occlusion of the pedicle was begun twice daily. Blood flow and haemoglobin oxygenation of the skin paddle were measured by laser Doppler flowmetry and photometry. At the 14th day of ischaemic preconditioning, the flap could tolerate 3h of occlusion. Then the carrier vessels and the forearm flap were excised. The flap survived completely based on neovascularization from the recipient site.     

Performance of different osteosynthesis materials in microvascular fibula free flap reconstruction

Fibular free flap (FFF) is the main reconstructive choice for large mandibular defects. Recent improvements have been made regarding planning and surgical procedure, but choice of osteosynthesis material (OSM) for segment-fixation remains controversial. A retrospective cohort study obtained clinical and radiological data from FFF-patients. Data were screened for OSM, surgical procedure and complications as OSM fractures, loosening, exposure, or insufficient osseous consolidation. Eighty patients with FFF were included. Planning was CAD/CAM (n=29), Recon Guide (n=26) or without planning (n=25). OSM was 2.0mm-miniplates in standard (n=26), preformed (n=6), CAD/CAM (n=14) or ReconGuide (n=23) variation and 2.3mm-reconstruction-plates in standard (n=5) or CAD/CAM (n=6) variation. Complications were observed in 21 cases, fractures occurred 10 times overall, but with low rates for preformed (n=1), ReconGuide (n=3) and none for CAD/CAM. Analysis detected significant correlations between used OSM and plate exposure (p = 0.000), but none regarding fracture (p = 0.275), loosening (p = 0.714) or insufficient osseous consolidation (p = 0.208). No correlations were observed between complications and OSM (p = 0.609) or diagnosis (p = 0.716). Fixation of FFF segments for reconstruction is possible with various OSM providing good clinical outcome. No significant differences were detected regarding prevention of complications by any osteosynthesis material (miniplate vs. macroplate). Although no differences were detected, miniplate usage is advocated whenever clinically reasonable, due to easier reintervention possibilities and reduced implanted foreign material. Nevertheless, decision for ideal OSM must remain patient-specific and cannot be generalised.     

计算机辅助游离腓骨下颌骨重建的术后效果评估

目的 建立一种标准化、可重复、简易的数字化评估方法,精确评估计算机辅助游离腓骨下颌骨重建术后效果.方法 通过对20例因肿瘤致下颌骨缺损后行计算机辅助游离腓骨下颌骨重建手术病例的回顾性分析,在Mimics Research 21.0及3-matic Research 13.0软件辅助下对重建术前与术后冠状向、矢状向与轴向...     

CAD/CAM制作个性化钛网联合髂骨移植重建单侧下颌骨大型轮廓缺损

目的 探讨CAD/CAM技术联合个性化预成型钛网及游离髂骨移植修复单侧下颌骨大型轮廓缺损的可行性及有效性.方法 选取四川大学华西口腔医院正颌及关节外科2015年11月—2019年12月的15例单侧下颌骨大型轮廓缺损的患者.采用基于逆向工程的计算机辅助设计/计算机辅助制作(CAD/CAM)技术,镜像重建患侧下颌骨轮廓并制...     

个性化重建板辅助游离腓骨重建上颌骨半侧缺损的优化设计

目的: 利用CAD/CAM以及3D打印技术体外辅助游离腓骨瓣重建上颌骨半侧缺损。方法: 利用CAD/CAM建立游离腓骨瓣重建上颌骨半侧缺损的三维模型,设计个性化重建板、截骨导板辅助重建完成,通过3D打印技术生成术前模型、截骨导板以及重建板,模型外科模拟手术。采用SPSS18.0软件包对数据进行统计学分析。结果: 快速建立了3段式游离腓骨重建上颌骨缺损的数字化模型,并设计生成原发灶截骨导板和重建辅助个性化重建板。定点测量显示,模型外科模拟重建精度与计算机模拟无显著差异（P>0.05）。结论: 优化设计的辅助措施和个性化重建板可以增加游离腓骨重建上颌骨缺损的准确性,有助于临床上精确外科重建。     

Free fibula flap for reconstruction of the severely atrophic mandible: a retrospective study

The purpose of this retrospective study was to assess the feasibility of using a free fibula flap (FFF) for reconstruction of the alveolar region of the severely atrophic mandible, by determining bone stability after dental implant insertion and prosthetic rehabilitation in a series of eight female patients aged 36–65 years. Dental implant insertion was performed 3–4 months after reconstruction. Prosthetic loading was performed 3–4 months after implant insertion. The height of the reconstructed mandible after surgery was 21.20 ± 1.87 mm, with an increase of 8.80 ± 1.71 mm from the preoperative height. The height of the FFF immediately after reconstruction was 11.24 ± 1.10 mm; this showed a vertical loss of 0.99 ± 0.52 mm (8.79%) and maintenance of 91.21% of the initial height at a mean 14 months post-reconstruction. Applying the Wical and Swoope formula to estimate the original mandibular body height, it was found that the difference between this calculated height (21.17 ± 3.76 mm) and the reconstructed height (21.20 ± 1.87 mm) was only 0.03 ± 3.17 mm (0.14%). An overall insignificant decrease of 0.46 ± 1.14 cm³ in FFF volume had occurred at 3–4 months after dental implant functional loading, while in two cases an increase in volume was found (1.22 cm³ and 1.71 cm³). The good and stable results obtained show that the FFF may be used to reconstruct the whole mandibular alveolar region, with the best possible outcomes.     

CAD／CAM口腔修复技术的研究现状

当今是一个科学与技术飞速发展、日新月异的时代，口腔修复医疗追求的最终目标是：个性化、美观、高效、简便地为患者设计、制作各类修复体。从目前实际情况看，口腔计算机辅助设计／计算机辅助制作（CAD／CAM）技术，在今后各类口腔修复体的设计与制作中必将成为主流技术，并将可能逐步淘汰传统铸造工艺。本文就CAD／CAM技术在口腔修复学中的应用作一综述。     

椅旁CAD/CAM技术在口腔修复中的应用

近年来,多种口腔修复用的CAD/CAM系统问世,一门新兴的口腔修复工艺已形成。本文就CAD/CAM技术的发展历史和组成、成熟椅旁CAD/CAM系统和修复材料、临床应用及存在的问题等方面作一综述。