个体化钛支架在构筑颌骨三维形态中的应用

目的　在运用快速成型技术制作的颌骨模型上作成个体化钛支架 ,以构筑颌骨三维形态。方法　 18例颌骨缺损患者进行个体化钛支架联合游离组织瓣修复重建。其中 10例上颌骨缺损以钛网支架重建上颌骨前壁、外侧及底壁 ,如内侧壁缺损则一并恢复 ,其口鼻创面以前臂皮瓣或串联腓骨肌瓣修复 ;8例下颌骨缺损以钛板支架塑形 ,联合游离腓骨 ,精确恢复下颌骨外形及髁突生理位置。结果　所有的病例随访 6～ 12个月 ,除 1例于术后9个月眶外侧壁复发外 ,其余未见肿瘤复发。皮瓣除 2例因术后放疗部分坏死外全部成活。所有患者面部外形均非常满意 ,张口度 2 .5～ 4cm ,正常进食。上颌骨重建病人无口鼻瘘 ,语音较为清晰 ,下颌髁突均在正常解剖生理位置 ,面部软组织亦很对称。结论　个体化钛支架应用于颌骨重建 ,能够较为精确地恢复颌骨外形 ,有利于术中引导移植骨准确对位 ,可避免术后的继发功能障碍 ,有效节省手术时间 ,其在复杂颅颌面疾病诊治中的应用前景非常乐观。

RECONSTRUCTION OF MAXILLARY and MANDIBULAR DEFECT WITH INDIVIDUAL TITANIUM MESH/PLATE-A CLINICAL STUDY

Objective Depending on rapid prototyping technique, an individual titanium frame based on 3D solid model was using to reconstruct the jaw. Methods Since June of 2001, we had been performed 18 cases of reconstruction of jaw, using an individual titanium frame. 10 cases of maxillary defect and 8 cases of mandibular defect were all underwent 3D CT and rapid prototype technique to get three dimensional model. An individual titanium mesh combined Chinese flap was used to reconstruct the maxilla based on 3D solid model, while an individual titanium plate combined fibular flap was used to reconstruct the manduble. Results 24 cases were followed up 6 12 months, all flaps were alive with satisfactory functional and aesthetic outcome. They were also confirmed tumor free by CT or MRI except one case. Their open mouth degree was from 2.5 to 4.0 cm and without nasal foods return. The condyle process was in the normal position. Conclusion Reconstruction of the jaw with an individual titanium frame was an ideal and practical method. It had a satisfactory recovery both of contour and function. It is recommended popularization on the complex cranio maxillofacial disease.