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

摘要

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.%Objective:To discuss and compare clinical outcomes between digital virtual surgical planning (VSP) and con-ventional experience method (CEM) for large segmental mandibular reconstruction using free fibula flap. Methods:A ret-rospective study was carried out on 15 patients who underwent fibula free flap surgery for mandibular reconstruction from January 2011 to December 2015. Patients were categorized by the type of reconstructive technique:CEM group ( n=9, be-tween 2011 and 2014) and VSP group (n=6, 2014 to 2015). Demographics, surgical factors, and clinical outcomes were compared. Results: Compared with cases in CEM group, those in VSP group needed less ischemia time and bony revi-sions, with better bony contact rate and appearance outcome. The difference between the angle of the mandible before and after operation was smaller in VSP group than in CEM group. There was not statistical significance in patients' mean age, operation time, stay length, and surgical success rate between two groups. Conclusion: Mandibular reconstruction using a VSP technique yielded significantly shorter ischemia time, higher reconstruction accuracy, and better aesthetic outcome.