羟基磷灰石在颅颌面骨缺损的修复

我们自 1 992年开始应用四川大学物理系和华西医科大学口腔医学院研制的致密多晶羟基磷灰石人工骨材料 (HA)用于颅颌面骨缺损、凹陷畸形的整复取得一些经验 ,效果满意 ,现报道如下。1　临床资料1 .1　一般资料本组病例男性 48例 ,女性 2 0 8例 ,年龄 1 9～ 47岁。 2 4例为颌骨囊肿 ,3 4例为外伤性颅颌面骨缺损畸形 ,1 0例为外伤性鞍鼻畸形 ,1 88例为先天性鞍鼻、低鼻患者。其中除 2 2例为重新植入羟基磷灰石外 ,均为首次植入 HA。1 .2　材料本组病例所采用的充填材料为 2 0 4 0型致密多晶羟基磷灰石微粒人工骨 (HA) ,微粒直径为 0 .4～0 …     

计算机辅助技术重建颅颌面骨缺损的应用及展望

计算机辅助设计和制造技术结合快速成型技术、数控加工技术、三维CT技术,用生物材料重建颅颌面骨缺损可以良好地恢复功能和外形。本文就计算机辅助设计和制造系统的组成、工作原理、临床应用进行总结,并对其发展作一展望。     

微型钛夹板在颌面骨骨折及缺损中的应用

本文作者应用自制的微型钛夹板固定颌面骨骨折，正颌截骨块，肿瘤术后骨不连接或骨质菲薄区及植骨块共７０例，随访７个月至２年半。结果证明微型钛夹板生物相容性良好，机械性能符合要求，是一种较理想的颌面骨内固定材料。     

计算机辅助技术重建颅颌面骨缺损的应用及展望

计算机辅助设计和制造技术结合快速成型技术、数控加工技术、三维CT技术，用生物材料重建颅颌面骨缺损可以良好地恢复功能和外形。本文就计算机辅助设计和制造系统的组成、工作原理、临床应用进行总结，并对其发展作一展望。     

CAD/CAM技术在牙体缺损嵌体修复中的应用

CAD/CAM技术是一种新型的修复技术,主要由数据采集系统、计算机辅助设计系统、计算机辅助制造系统3部分子系统组成,具有高效、美观和精确的特点。该文旨在将CAD/CAM技术的原理、步骤及预后情况作一综述,阐示CAD/CAM技术的原理、步骤及预后可能出现的情况,增加对CAD/CAM技术的了解。     

预制皮瓣在口腔颌面部缺损修复中的应用

预制皮瓣就是根据缺损整复的需要，将血管束预先转移到皮瓣内使皮瓣获得血管化后再带蒂转移或游离移植；或将骨和一些组织（如皮肤、筋膜、黏膜等）或人工材料预先转移到组织瓣内或组织瓣的筋膜面，进行“雕塑”制成具有三维立体结构的复合组织瓣，形成预构“器官”，待血循环建立后再以显微外科手段或带蒂方式将组织瓣转移到缺损区进行缺损的修复重建，口腔颌面部器官的形态复杂，如耳、鼻、唇等不仅外形不规则，而且具有三维立体结构。当上述器官缺如或缺损时，不论使用何种传统皮瓣，重建后的外形均不尽人意。由于预构皮瓣是在转移修复前将所需组织转移到血管区或将血管束转移到所需组织下，使临床医生有充裕的时间和空间模仿器官外形进行几何设计和外科制备，使得所预先构建的“器官”形态逼真。此种技术的应用．将极大改观口腔颌面部器官缺损修复重建的外观．达到一定美容效果，有效提高器官缺损患者的生存质量。     

富血小板血浆及其在口腔颌面骨修复中的应用

1984年,Assoion等发现了人血浆中提取的富血小板血浆（platelet—rich plasma,PRP）中含有多种生长因子,当PRP与氯化钙以及凝血酶混合后,各种生长因子即从血小板中的仪颗粒中释放出来^[1]。这些生长因子包括血小板源性生长因子（platelet—derived growth factor,PDGF）、转化生长因子β（transforming growth factor—β,TGF—β）、     

自制栓道式附着体在面颊颌缺损修复中的应用

目的:探讨自制栓道式附着体在面颊缺损修复中的应用.方法:对1例颜面颌骨复杂缺损患者,通过设计栓道式附着体,连接面颊赝复体和口内赝复体,完成牙列、上颌骨及右面颊缺损的联合修复.结果:面颊赝复体和口内赝复体固位良好,患者容貌恢复较好,咀嚼功能得到提高.结论:自制栓道式附着体在颜面颌骨复杂缺损修复方面有较大的应用价值.     

中空阻塞器仪颌在上颌骨缺损修复中的应用效果

本文随机抽样复查１０例上颌骨肿瘤摘除术后缺损，用中空阻塞器仪颌重建者，通过复查作出的临床评价表明，戴修复体后在改善患者术后畸形的面容和恢复口腔生理功能等方面均感满意，有效地提高了患者的生存质量。     

Three-dimensional CAD/CAM reconstruction of the iliac bone following DCIA composite flap harvest

This article reports a new technique to restore iliac bone integrity with a customized titanium device designed by CAD/CAM, in patients undergoing deep circumflex iliac artery (DCIA) composite flap harvest. Eight consecutive patients who underwent the repair of major head and neck defects with DCIA flaps were enrolled retrospectively. Computed tomography scans of the pelvis were obtained preoperatively. Starting from DICOM data, each personalized device was designed using modelling software and was finally made by additive manufacturing using a laser sintering machine. After surgery, the patients were followed up at 3-month intervals to evaluate the incidence of complications and the long-term outcome at the donor site. A subcutaneous seroma developed in one patient and an inguinal skin burn occurred in another. At a median follow-up of 12 months, the patients did not report pain, or any gait or sensory disturbance at the donor site. There was no occurrence of bulging, herniation, or instability or inflammation near the device for the entire follow-up duration. All patients were satisfied with the aesthetic result. In conclusion, reconstruction of the iliac bone with a customized device is safe and well tolerated. We recommend use of this device in patients deemed at high risk of herniation. Further studies are needed to confirm the stability of the device in the long term.     

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口腔颌面部骨组织结构是支撑面型的重要基础,发生在口腔颌面部的外伤、肿瘤、先天畸形是引发患者口腔颌面部骨组织缺损的主要原因,而如何在一期对患者面型及骨组织缺损进行修复也是口腔颌面外科手术中亟待解决的重点和难点问题。本文主要总结了口腔颌面部骨组织缺损修复材料的发展。     

Navigation-assisted maxillofacial reconstruction: accuracy and predictability

The aim of this study was to evaluate the accuracy of navigation-assisted maxillofacial reconstruction and to identify the predictors of the clinical outcomes. A total of 112 patients who underwent navigation-assisted maxillofacial reconstruction with free flaps between 2014 and 2019, performed by a single surgical team, were assessed. Accuracy was evaluated by superimposing the postoperative computed tomography data with the preoperative virtual surgical plan. Predictors of the clinical outcomes affecting the accuracy were identified and analysed. The mean deviation and root mean square (RMS) estimate of the orbital, maxillary, and mandibular reconstructions were 0.88 ± 3.25 mm and 3.38 ± 0.73 mm, 0.77 ± 3.44 mm and 3.69 ± 0.82 mm, and 1.07 ± 4.16 mm and 4.67 ± 3.95 mm, respectively (P < 0.05). There was no significant difference in orbital volume or projection between the preoperative, postoperative, and healthy orbits (P = 0.093 and P = 0.225, respectively). Multivariate linear regression analysis confirmed significant associations between the accuracy of navigation-assisted mandibular reconstruction and preservation of the condyle, type of reconstruction, type of osteosynthesis plate, and number of bony segments. Navigation-assisted midface reconstruction yielded a higher level of accuracy in the final surgical outcome when compared to mandibular reconstruction. Computer-assisted techniques and intraoperative navigation can be an alternative or adjunct to current surgical techniques to improve the final surgical outcome, especially in more complex maxillofacial reconstructions.     

穿支皮瓣在口腔颌面部缺损重建中的应用

穿支皮瓣是由以管径细小(0.5~0.8 mm)的穿支血管供血的,包含皮肤或者皮下组织的轴型血管皮瓣.因其具有供区损伤小及受区功能好等特点,穿支皮瓣被广泛应用于口腔颌面部缺损重建修复中.目前,关于穿支皮瓣在口腔颌面部缺损重建中的报道越来越多,但是关于皮瓣术前穿支定位以及皮瓣修复后期削薄方面的研究较少.本文就穿支皮瓣的特点、分类、解剖学基础及其在口腔颌面部缺损修复重建应用中的相关问题作一综述.     

口腔颌面部缺损游离皮瓣修复中血管吻合的技巧及关键点

血管吻合的质量是决定游离皮瓣移植修复术是否成功最为关键的因素。游离皮瓣在修复口腔颌面部缺损的应用中存在血管选择、受区血管相关术中表现和血管吻合技术等方面的诸多特点及技巧。同时,术后对皮瓣危象、并发症进行判断和处理时也有较多的关键点。笔者的团队在近年来开展了大量的口腔颌面缺损游离皮瓣修复,在口腔颌面颈部的血管吻合方面积累了大量的经验。本文针对口腔颌面缺损游离皮瓣修复中动静脉吻合的技巧、血管选择、血管危象的判断及处理等问题进行评述。     

类骨质羟磷灰石和自体骨修复兔下颌骨临界性骨缺损的研究

目的探讨类骨质羟磷灰石（SBR）的生物相容性,并探讨该替代材料和自体骨混合修复骨缺损的生物学特性。方法选用新西兰大白兔,在实验动物双侧下颌骨内侧形成10 mm×10 mm×2 mm大小的临界性缺损,左侧骨缺损按照1∶1比例植入SBR和自体骨,右侧骨缺损内分别植入自体骨或缺如,术后2、4、8周取标本,进行大体标本、X线、组织学和Masson新三色染色法的形态学分析。结果生物替代物具有良好的生物相容性,与自体骨混合能有效地促进骨缺损的修复愈合。骨髓细胞很容易在该材料表面黏附,自体骨的加入更有利于新骨长入材料的孔隙中,分化增殖,形成骨基质,并钙化成熟。结论SBR是一种良好的骨替代材料,自体骨的加入更有利于早期成骨和替代材料的自我改建的完成。     

Development of the clinical use of distant flaps for head and neck reconstruction

The reconstruction of hard and soft tissue defects, mainly after ablative oncologic surgery in the head and neck area, is an evolving field. The use of free flaps for reconstruction of the head and neck is considered to be the surgical standard. In our analysis of more than 1000 free flaps we give an overview of the development of the use of different types of free tissue transfer to the head and neck area over the last 25 years. We show that the evolving field of head and neck reconstruction raises new possibilities with new types of flaps, whereas other types of flaps disappear in the everyday clinical use. The spectrum of reconstruction possibilities broadens with the number of different flap types available to the head and neck surgeon.     

Matching locating holes in multiple plates to record bone position for accurate reconstruction after segmental mandibulectomy

Segmental defect areas in the mandible can change immediately following osteotomy due to muscular traction, impacting on accurate reconstruction. The purpose of this article is to introduce a new technique based on virtual surgery planning to record the position of the bony parts prior to mandibulectomy, for use in precise mandibular reconstruction after segmental osteotomy. The position information for the bony parts is transferred to a plate with complementary surface contact and locating holes with specific directions and angles. This technique was performed for six patients with segmental defects and the results were compared to those of six previous patients in whom the technique was not utilized. The design of the location holes shortened the average operation time from 406 minutes to 349 minutes (P = 0.033) and decreased the average, maximum, and minimum graft deviation from 1.21 mm to 0.88 mm (P = 0.015), 1.28 mm to 0.99 mm (P = 0.027), and −1.15 mm to −0.77 mm (P = 0.077), respectively. The design of the locating holes in multiple plates shortened the time taken for the bony repositioning step and hence significantly shortened the total operation time. More importantly, it also increased the reconstructive accuracy.