【摘要】：目的:研究多種數(shù)字化技術(shù)在移植腓骨精確化重建上頜骨及下頜骨手術(shù)中的臨床應(yīng)用現(xiàn)況并分析其局限性與改進(jìn)方向。方法:收集了浙江大學(xué)附屬第一醫(yī)院2015年2月至2016年12月期間收治的應(yīng)用了包括薄層CT,CAD/CAM術(shù)前設(shè)計(jì),模型外科,以及術(shù)中計(jì)算機(jī)導(dǎo)航等多種數(shù)字化技術(shù)進(jìn)行腓骨瓣移植重建下頜骨的患者共10例,詳細(xì)記錄術(shù)中所見,術(shù)后予以密切隨訪。其中7例為成釉細(xì)胞瘤,1例牙齦癌,1例頰癌,1例牙源性角化囊性瘤。依據(jù)這]0例病例資料分析術(shù)中記錄與術(shù)后隨訪情況,得出結(jié)果與結(jié)論。結(jié)果:10例患者中9例患者手術(shù)均順利按術(shù)前設(shè)計(jì)完成,1例患者因術(shù)后肌皮瓣吻合血管血栓形成,經(jīng)二次手術(shù)由血管化腓骨肌皮瓣移植改為游離腓骨移植。術(shù)后所有患者面部外形均良好,未出現(xiàn)明顯手術(shù)并發(fā)癥,功能無明顯影響。對9位患者術(shù)前術(shù)后CT影像進(jìn)行了配準(zhǔn)后測量髁狀突偏移度,平均偏移6.82±4.97mm結(jié)論:多種數(shù)字化技術(shù)的聯(lián)合應(yīng)用,可以使術(shù)前手術(shù)方案的設(shè)計(jì)更加精確、直觀,便于與患者及家屬溝通,并有利于實(shí)現(xiàn)精準(zhǔn)醫(yī)學(xué)。但目前的技術(shù)仍然存在一定的局限性,有些方面仍需技術(shù)的進(jìn)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 鹵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.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R782

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