虚拟手术辅助的腓骨肌（皮）瓣在上颌骨 精确重建中的应用

Using virtual surgery for accurate maxillary reconstruction with vascularized fibula osteomyocutaneous flap

摘要:

目的回顾性分析经虚拟手术辅助的血管化腓骨肌皮瓣行上颌骨精确重建的病例，并评价术后效果。方法2009年6月~2014年7月对34例上颌骨缺损患者术前通过虚拟手术模拟上颌骨全切或次全切除，并通过比较腓骨与健侧上颌骨镜像的形态，对重建上颌骨精确塑形。术中使用立体模型和手术导板再现术前计划，并将实际重建效果与虚拟手术结果进行对比。术后1年对所有患者面部外形进行满意度评估。结果34例上颌骨缺损患者术后1年随访显示重建的上颌骨均愈合良好、咬合关系正常，实际重建效果与虚拟手术结果基本一致；且患者对面部外形非常满意或满意。结论结合义齿修复，虚拟手术辅助的血管化腓骨肌皮瓣行上颌骨精确重建能重建上颌骨的理想外形和良好功能。

关键词:虚拟手术|上颌骨重建|腓骨肌皮瓣

Abstract:

Abstract:ObjectiveTo review the clinical data of patients who underwent accurate maxillary reconstruction with vascularized fibula osteomyocutaneous flap using virtual surgery and to evaluate the postoperative results.MethodsFrom June 2009 to July 2014, 34 patients with maxillary defect were treated in our department. In virtual surgical planning, total and subtotal maxillectomy were simulated and fibula was superimposed mirror image of normal maxilla to complete accurate maxillary reconstruction. Total and subtotal maxillectomy and maxillary reconstruction were performed using stereomodels and guided templates to replicate the virtual planning. Actual reconstruction result was compared with that of virtual surgery. The patients were asked to assess their satisfaction with facial appearance at one year after operation.ResultsGood bony unions and occlusion were observed in 34 patients. The actual results were basically in accordance with those of virtual surgery. All patients reported excellent or good facial appearances at one year postoperatively.ConclusionThe ideal contour of neomaxilla and good function with dental rehabilitation can be obtained after accurate maxillary reconstruction with vascularized fibula osteomyocutaneous flap using virtual surgery.

Key words:Virtual surgery| Maxillary reconstruction| Vascularized fibula osteomyocutaneous flap