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。

Reconstruction of extensive bilateral mandibular defects using CAD/CAM rapid prototyping technique in combination with fibular osteomyocutaneous free flap

PURPOSE：To investigate an optimal method to reproduce anatomical shape and occlusal function of extensive bilateral mandibular defect.METHODS：Fifteen patients with lesion involving bilateral mandible and needed for segmental resection were underwent preoperative CT scan.The 3-dimensional virtual models and the solid physical models of the mandible were created by computer-aided design/computer-aided manufacture（CAD/CAM） system and rapid prototyping technique.The osteotomy lines and the shape of reconstruction titanium meshes were designed based on solid models.Titanium meshes were punched by CNC machine and ensured to match the shape of mandibles ready for resection.Fibula osteomyocutaneous free flaps were harvested and transplanted together with prefabricated titanium meshes to repair the large mandibular defects.RESULTS：All free fibular flaps survived well.Wounds healed.No titanium mesh exposure was observed during the follow-up period.The anatomical shape of mandibles including the natural arch,curvature and height recovered satisfactorily.All patients＇ appearance with immediate reconstruction presented no significant change before and after surgery.CONLUSIONS：CAD/CAM rapid prototyping technique combined with free fibular flap graft to repair extensive bilateral mandibular defect can not only rehabilitate the natural shape of the mandible,maintain the patient＇ appearance,but also create favorable conditions for dental implant and occlusal reconstruction.