数字化技术在腓骨瓣精确化重建下颌骨手术中的临床应用

发布时间：2018-07-28 21:06

【摘要】：目的:研究多种数字化技术在移植腓骨精确化重建上颌骨及下颌骨手术中的临床应用现况并分析其局限性与改进方向。方法:收集了浙江大学附属第一医院2015年2月至2016年12月期间收治的应用了包括薄层CT,CAD/CAM术前设计,模型外科,以及术中计算机导航等多种数字化技术进行腓骨瓣移植重建下颌骨的患者共10例,详细记录术中所见,术后予以密切随访。其中7例为成釉细胞瘤,1例牙龈癌,1例颊癌,1例牙源性角化囊性瘤。依据这]0例病例资料分析术中记录与术后随访情况,得出结果与结论。结果:10例患者中9例患者手术均顺利按术前设计完成,1例患者因术后肌皮瓣吻合血管血栓形成,经二次手术由血管化腓骨肌皮瓣移植改为游离腓骨移植。术后所有患者面部外形均良好,未出现明显手术并发症,功能无明显影响。对9位患者术前术后CT影像进行了配准后测量髁状突偏移度,平均偏移6.82±4.97mm结论:多种数字化技术的联合应用,可以使术前手术方案的设计更加精确、直观,便于与患者及家属沟通,并有利于实现精准医学。但目前的技术仍然存在一定的局限性,有些方面仍需技术的进步。
[Abstract]:Objective: to study the clinical application of various digital techniques in the accurate reconstruction of maxilla and mandible with fibula graft, and to analyze its limitation and improvement direction. Methods: from February 2015 to December 2016, the patients admitted to the first affiliated Hospital of Zhejiang University were treated with TLC CTD / CAM preoperative design and model surgery. Ten cases of mandibular reconstruction with fibula flap transplantation were performed with computer navigation and other digital techniques. The intraoperative findings were recorded in detail and followed up closely after operation. 7 cases were ameloblastoma 1 case gingival carcinoma 1 case buccal carcinoma 1 case odontogenic keratocyst tumor. According to the data of 0 cases, the intraoperative records and postoperative follow-up were analyzed, and the results and conclusions were obtained. Results 9 out of 10 patients underwent successful operation according to the preoperative design. One patient underwent vascularized vasoembolization of myocutaneous flap and the second operation was changed from vascularized fibula myocutaneous flap to free fibula graft. All the patients had good facial appearance and no obvious complications. The condylar deviation was measured after registration of CT images of 9 patients before and after operation. The average deviation was 6.82 卤4.97mm. Conclusion: the combination of various digital techniques can make the design of preoperative operation more accurate and intuitionistic. Easy to communicate with patients and family members, and to achieve precision medicine. But the present technology still has certain limitation, some aspects still need the technical progress.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R782

【相似文献】