计算机辅助游离腓骨下颌骨重建的术后效果评估

doi:10.7518/hxkq.2022.02.010

华西口腔医学杂志 ›› 2022, Vol. 40 ›› Issue (2): 189-196.doi: 10.7518/hxkq.2022.02.010

计算机辅助游离腓骨下颌骨重建的术后效果评估

康泽标¹(), 买晓雪¹, 王鑫¹, 谢富强¹^,²()

^1.兰州大学口腔医学院口腔颌面外科教研室，兰州 730000
^2.兰州大学第二医院口腔科，兰州 730000

收稿日期:2021-06-10 修回日期:2022-01-30 出版日期:2022-04-01 发布日期:2022-04-01
通讯作者: 谢富强 E-mail:kangzb19@lzu.edu.cn;xiefq@lzu.edu.cn
作者简介:康泽标，硕士，E-mail：kangzb19@lzu.edu.cn
基金资助:
甘肃省科技厅自然科学基金项目(20JR10RA737)

Evaluation of the postoperative effect of computer-assisted free fibula mandibular reconstruction

Kang Zebiao¹(), Mai Xiaoxue¹, Wang Xin¹, Xie Fuqiang¹^,²()

^1.Dept. of Oral and Maxillofacial Surgery, School of Stomatology Lanzhou University, Lanzhou 730000, China
^2.Dept. of Stomatology, Lanzhou University Second Hospital, Lanzhou 730000, China

Received:2021-06-10 Revised:2022-01-30 Online:2022-04-01 Published:2022-04-01
Contact: Xie Fuqiang E-mail:kangzb19@lzu.edu.cn;xiefq@lzu.edu.cn
Supported by:
The Natural Science Foundation of Science and Technology Department of Gansu Province(20JR10-RA737);Correspondence: Xie Fuqiang, E-mail: xiefq@lzu.edu.cn

摘要/Abstract

摘要： 目的

建立一种标准化、可重复、简易的数字化评估方法，精确评估计算机辅助游离腓骨下颌骨重建术后效果。

方法

通过对20例因肿瘤致下颌骨缺损后行计算机辅助游离腓骨下颌骨重建手术病例的回顾性分析，在 Mimics Research 21.0及3-matic Research 13.0软件辅助下对重建术前与术后冠状向、矢状向与轴向下颌角进行测量分析，评估计算机辅助游离腓骨下颌骨重建术后效果。

结果

在计算机辅助游离腓骨下颌骨重建的20例患者中，术前健侧和患侧冠状下颌角、轴向下颌角差异无统计学意义（P>0.05），矢状下颌角差异有统计学意义（P<0.05）；术后健侧和患侧冠状、矢状、轴向下颌角差异均无统计学意义（P>0.05）。术前与术后健侧和患侧冠状、矢状、轴向下颌角差值的绝对值差异有统计学意义（P<0.01）。Ⅰ类缺损术前健侧和患侧矢状下颌角、术后健侧和患侧轴向下颌角差异有统计学意义（P<0.05），其余各类缺损术前与术后健侧和患侧三维下颌角差异均无统计学意义（P>0.05）。Ⅰ类缺损术前与术后健侧和患侧矢状、冠状下颌角差值的绝对值差异无统计学意义（P>0.05），其余各类缺损术前与术后健侧和患侧三维下颌角差值的绝对值差异均有统计学意义（P<0.05）。

结论

计算机辅助游离腓骨下颌骨重建对于肿瘤造成的三维方向的颌骨畸形均有显著的改善，能有效恢复下颌骨解剖结构的精确对称，应用本研究的评估方法能精确地评估下颌骨重建术后效果，为术前的设计提供指导。

关键词: 下颌骨重建, 计算机辅助手术, 精确度, 游离腓骨皮瓣

Abstract: Objective

This study aims to establish a standardized, repeatable, and simple digital evaluation method for accurately determining the effect of computer-assisted free fibula mandibular reconstruction.

Methods

A total of 20 mandibular defect cases caused by tumors were analyzed retrospectively. The coronal, sagittal, and axial mandibular angles were measured and analyzed with Mimics Research 21.0 and 3-matic Research 13.0 software before and after surgery. The effect of computer-assisted free fibula mandibular reconstruction was evaluated.

Results

No significant difference was observed in the coronal and axial mandibular angles between the healthy and affected sides before operation (P>0.05). By contrast, a significant difference in sagittal mandibular angle (P<0.05) was noted. No significant difference was found in the coronal, sagittal, and axial mandibular angles between the healthy and affected sides after operation (P>0.05). Conversely, a significant difference was recorded in the absolute value of the coronal, sagittal, and axial mandibular angles between the healthy and affected sides pre-operation and post-operation (P<0.01). Meanwhile, a significant difference was observed in the sagittal mandibular angle between the healthy and affected sides before operation and the axial mandibular angle between the healthy and affected sides after operation in Type Ⅰ defect (P<0.05). Moreover, no significant difference in the 3D mandibular angle was found between the healthy and affected sides before and after operation in other types (P>0.05). Furthermore, no significant difference was recorded in the absolute values of the sagittal and coronal mandibular angles between the healthy and affected sides before and after operation in Type Ⅰ defect (P>0.05). Lastly, a significant difference was found in the absolute values of the 3D mandibular angles between the healthy and affected sides before and after operation in other types (P<0.05).

Conclusion

Computer-assisted free fibula mandibular reconstruction can significantly improve 3D mandibular deformities caused by tumors and effectively restore the accurate symmetry of the mandibular anatomical structure. The evaluation method used in this study can accurately evaluate the effects of mandibular reconstruction and provide guidance to preoperative design.

Key words: mandibular reconstruction, computer-assisted surgery, accuracy, free fibula flap

中图分类号:

R 782.05

康泽标, 买晓雪, 王鑫, 谢富强. 计算机辅助游离腓骨下颌骨重建的术后效果评估[J]. 华西口腔医学杂志, 2022, 40(2): 189-196.

Kang Zebiao, Mai Xiaoxue, Wang Xin, Xie Fuqiang. Evaluation of the postoperative effect of computer-assisted free fibula mandibular reconstruction[J]. West China Journal of Stomatology, 2022, 40(2): 189-196.

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患者	年龄/岁	性别	病理诊断	缺损类型	术中失血量/mL	住院时长/d
1	35	女	骨化纤维瘤	Ⅰ类	200	48
2	49	男	成釉细胞瘤	Ⅰ类	250	30
3	54	男	成釉细胞瘤	Ⅱc类	220	31
4	58	男	成釉细胞瘤	Ⅰ类	230	32
5	17	女	角化囊性瘤	Ⅱ类	300	25
6	19	男	角化囊性瘤	Ⅱ类	200	28
7	41	女	成釉细胞瘤	Ⅱ类	250	31
8	41	女	成釉细胞瘤	Ⅱ类	230	30
9	19	女	成釉细胞瘤	Ⅱc类	280	29
10	59	男	成釉细胞瘤	Ⅰ类	100	20
11	30	男	成釉细胞瘤	Ⅱc类	240	34
12	40	女	成釉细胞瘤	Ⅱ类	200	25
13	34	男	成釉细胞瘤	Ⅱc类	500	29
14	46	男	成釉细胞瘤	Ⅰ类	250	30
15	55	女	成釉细胞瘤	Ⅰ类	120	20
16	20	女	骨化纤维瘤	Ⅱc类	200	31
17	35	女	成釉细胞瘤	Ⅱc类	220	28
18	55	男	成釉细胞瘤	Ⅱc类	200	32
19	45	男	成釉细胞瘤	Ⅱc类	210	35
20	22	女	骨化纤维瘤	Ⅰ类	200	37
平均值	38.70±13.72	-	-	-	230±76.35	30.25±5.85

患者	术前						术后
	冠状下颌角/°		矢状下颌角/°		轴向下颌角/°		冠状下颌角/°		矢状下颌角/°		轴向下颌角/°
	健侧	患侧	健侧	患侧	健侧	患侧	健侧	患侧	健侧	患侧	健侧	患侧
P值	0.918		0.039		0.299		0.539		0.074		0.122
1	23.74	25.27	10.27	25.39	74.89	64.89	22.61	22.84	11.61	16.63	73.48	73.32
2	6.02	23.20	23.86	28.74	60.81	58.95	6.97	9.75	24.19	28.03	59.54	56.76
3	18.41	13.82	32.63	24.33	61.07	64.60	18.45	16.65	29.16	31.62	61.72	61.21
4	21.75	16.63	25.51	25.49	65.31	60.77	22.11	23.52	26.37	25.56	67.56	66.78
5	12.99	14.99	25.08	28.45	71.45	67.34	14.72	13.46	24.63	25.79	70.66	69.51
6	9.60	23.03	23.88	33.62	51.99	60.01	10.67	12.18	23.49	20.55	50.97	52.98
7	16.53	15.90	23.57	22.44	62.01	60.80	17.43	17.81	22.30	23.68	62.30	62.83
8	8.74	6.31	31.45	27.82	52.33	49.13	7.72	6.58	31.05	29.98	53.94	54.67
9	15.04	7.49	30.89	25.53	66.23	71.82	15.29	14.98	29.45	31.31	65.54	67.42
10	24.10	17.95	23.02	25.89	65.29	59.43	25.01	24.05	24.49	25.11	66.34	62.71
11	14.58	12.38	31.44	36.99	59.19	56.69	14.99	16.80	36.00	37.61	60.19	61.45
12	17.81	13.06	26.54	27.95	65.91	70.26	18.77	17.63	26.18	26.98	66.76	65.68
13	7.06	19.23	32.45	29.28	85.34	81.83	8.27	12.68	32.40	30.49	86.96	84.75
14	28.04	16.26	14.26	31.61	57.46	55.41	29.26	27.03	15.65	19.96	57.37	56.79
15	18.11	18.36	38.69	40.37	77.73	62.73	17.96	16.44	39.44	38.23	78.68	76.00
16	19.16	6.43	31.66	26.17	72.22	69.30	18.68	19.32	30.21	27.66	72.11	71.08
17	20.86	19.15	25.16	31.91	57.52	63.64	21.62	21.29	26.64	27.55	59.90	61.69
18	16.65	12.92	27.86	31.37	68.68	55.73	15.69	16.18	29.22	31.15	67.63	66.51
19	13.67	20.56	23.45	40.36	76.72	80.67	13.86	13.46	24.24	25.37	75.86	76.49
20	15.67	21.88	21.84	34.32	78.74	85.99	15.78	17.98	21.89	23.67	77.64	73.56
平均值	16.43±5.80	16.24±5.46	26.18±6.50	29.90±5.13	66.54±9.12	65.00±9.46	16.79±5.76	17.03±5.06	26.43±6.31	27.35±5.36	66.76±8.98	66.11±8.16

缺损类型	术前平均值									术后平均值
	冠状下颌角/°		P值	矢状下颌角/°		P值	轴向下颌角/°		P值	冠状下颌角/°		P值	矢状下颌角/°		P值	轴向下颌角/°		P值
	健侧	患侧	P值	健侧	患侧	P值	健侧	患侧	P值	健侧	患侧	P值	健侧	患侧	P值	健侧	患侧	P值
Ⅰ类	19.63±7.25	19.94±3.51	0.935	22.49±9.05	30.26±5.60	0.027	68.60±8.49	64.02±10.14	0.134	19.96±7.23	20.23±5.88	0.721	23.38±8.84	25.31±6.84	0.088	68.66±8.38	66.56± 8.06	0.012
Ⅱ类	13.13±4.04	14.66±6.00	0.656	26.10±3.21	28.06±3.96	0.439	60.74±8.52	61.51±8.16	0.758	13.86±4.62	13.53±4.62	0.581	25.53±3.40	25.40±3.54	0.879	60.93±8.35	61.13± 7.11	0.745
Ⅱc类	15.68±4.26	14.00±5.35	0.566	29.44±3.52	30.74±5.66	0.676	68.37±9.51	68.04±9.84	0.887	15.86±3.97	16.42±2.86	0.422	29.67±3.53	30.35±3.70	0.337	68.74±9.30	68.83±8.35	0.877

缺损类型	冠状下颌角差值的绝对值/°		P值	矢状下颌角差值的绝对值/°		P值	轴向下颌角差值的绝对值/°		P值
缺损类型	术前	术后	P值	术前	术后	P值	术前	术后	P值
Ⅰ类	6.89±5.87	1.62±0.86	0.037	7.77±7.04	2.51±1.83	0.053	6.65±4.66	2.10±1.57	0.044
Ⅱ类	4.65±5.13	1.09±0.42	0.176	3.86±3.48	1.47±0.85	0.122	4.18±2.48	1.10±0.57	0.023
Ⅱc类	6.45±4.22	1.27±1.41	0.007	6.88±4.37	1.80±0.57	0.017	5.13±3.40	1.30 ±0.61	0.018

患者	冠状下颌角差值的绝对值/°		矢状下颌角差值的绝对值/°		轴向下颌角差值的绝对值/°
患者	术前	术后	术前	术后	术前	术后
P值	0.000		0.000		0.000
1	1.53	0.23	15.12	5.02	10.00	0.16
2	17.18	2.78	4.88	3.84	1.86	2.78
3	4.59	1.80	8.30	2.46	3.53	0.51
4	5.12	1.41	0.02	0.81	4.54	0.78
5	2.00	1.26	3.37	1.16	4.11	1.15
6	13.43	1.51	9.74	2.94	8.02	2.01
7	0.63	0.38	1.13	1.38	1.21	0.53
8	2.43	1.14	3.63	1.07	3.20	0.73
9	7.55	0.31	5.36	1.86	5.59	1.88
10	6.15	0.96	2.87	0.62	5.86	3.63
11	2.20	1.81	5.55	1.61	2.50	1.26
12	4.75	1.14	1.41	0.80	4.35	1.08
13	12.17	4.41	3.17	1.91	3.51	2.21
14	11.78	2.23	17.35	4.31	2.05	0.58
15	0.25	1.52	1.68	1.21	15.00	2.68
16	12.73	0.64	5.49	2.55	2.92	1.03
17	1.71	0.33	6.75	0.91	6.12	1.79
18	3.73	0.49	3.51	1.93	12.95	1.12
19	6.89	0.40	16.91	1.13	3.95	0.63
20	6.21	2.20	12.48	1.78	7.25	4.08
平均值	6.15± 4.88	1.35± 1.03	6.44± 5.27	1.97± 1.23	5.43± 3.66	1.53± 1.08

计算机辅助游离腓骨下颌骨重建的术后效果评估

Evaluation of the postoperative effect of computer-assisted free fibula mandibular reconstruction

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