数字化导板在下颌骨良性病变截骨并保存下牙槽神经血管束中的应用：附1例报告

中国口腔颌面外科杂志 ›› 2014, Vol. 12 ›› Issue (1): 45-50.

数字化导板在下颌骨良性病变截骨并保存下牙槽神经血管束中的应用：附1例报告

黄栋¹, 何冬梅^{1, *}, 杨驰^{1, *}, 陈敏洁¹, 袁建兵², 白果¹, 陈琢之¹

1.上海交通大学医学院附属第九人民医院·口腔医学院口腔外科,上海市口腔医学重点实验室,上海 200011; 2.上海交通大学机械动力工程学院,上海 200240

收稿日期:2013-07-29 修回日期:2013-11-22 出版日期:2014-02-10 发布日期:2014-02-10
通讯作者: 杨驰,Tel:021-23271699-5218,Fax：021-63136856,E-mail：yangchi63@hotmail.com；何冬梅,E-mail:lucyhe119@163.com。*共同通信作者
作者简介:黄栋(1986-),男,硕士,住院医师,E-mail:pociman@126.com
基金资助:
上海市科学技术委员会资助项目(08DZ2271100, 13XD1402300); 上海交通大学医工交叉基金(YG2009MS42); 衷心感谢Materialize公司孙涛工程师在数据处理过程中给予的大力帮助！)

Application of digital guide in the osteotomy of benign lesions in mandible with preservation of the inferior alveolar neurovascular bundle: report of one case

HUANG Dong¹, HE Dong-mei¹, YANG Chi¹, CHEN Min-jie¹, YUAN Jian-bing², BAI Guo¹, CHEN Zhuo-zhi¹

1.Department of Oral Surgery, Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine； Shanghai Key Laboratory of Stomatology. Shanghai 200011; 2.School of Mechanical and Power Engineering, Shanghai Jiao Tong University. Shanghai 200240, China

Received:2013-07-29 Revised:2013-11-22 Online:2014-02-10 Published:2014-02-10
Supported by:
Supported by Research Fund of Science and Technology Committee of Shanghai Municipality (08DZ2271100, 13XD1402300) and Research Fund of Biomedical Engineering of Shanghai Jiao Tong University (YG2009MS42).

摘要/Abstract

摘要： 目的: 探讨数字化导板在保存下牙槽神经血管束的下颌骨良性病变治疗中的应用方法,并评价其应用效果。方法：下颌支骨化纤维瘤病1例,ProPlan CMF 1.3软件处理CT数据,标记患侧下牙槽神经管,并于其下方2 mm设计截骨线。制作相应数字化导板,指导术中截骨并分离神经；利用反求技术制作定位导板,定位预制的重建钛板。术后CT评价面部对称性与截骨的准确性,同时检测双侧颏部皮肤感觉、下颌牙牙髓活力,以评价神经功能。采用SPSS 17.0软件包对数据进行统计学分析。结果：应用导板截除病变彻底,术中完整剥离并保存下牙槽神经血管束。术后随访示面形对称,患侧下唇感觉存在,患侧下颌牙牙髓活力与健侧无显著差异。结论：数字化导板可帮助实现下颌骨良性病变的彻底切除、下牙槽神经血管束的保存和同期肋骨移植颌骨重建,是功能性外科的有力辅助工具。

关键词: 数字化导板, 下牙槽神经血管束, 下颌骨重建

Abstract: PURPOSE: To discuss the application of digital guide in the treatment of benign lesions in mandible with preservation of the inferior alveolar neurovascular bundle, and to evaluate its effect. METHODS: Preoperative planning based on CT data of a patient with mandibular ossifying fibroma (OF) was done using ProPlan CMF 1.3. The mandibular canal on the affected side was segmented, and a special digital guide was made to guide the osteotomy 2 mm below the canal to preserve the inferior alveolar neurovascular bundle, and mirrored mandible was used to help the positioning of the reconstruction plate. The design and the postoperative CT was merged using the software to evaluate the accuracy of osteotomy, the sensation of lower lip and the pulp vitality were measured to evaluate the function of the inferior alveolar nerve. SPSS 17.0 software package was used for statistical analysis. RESULTS: The operation successfully removed the affected mandible and preserved the inferior alveolar neurovascular bundle. The costochondral flap was positioned accurately according to the guide. Follow-up results showed good facial symmetry, existence of the sensation in lower lip and no significant difference between the pulp vitality on both sides. CONCLUSIONS: The application of digital guide can help resection of mandibular benign lesions, as well as preserving the inferior alveolar neurovascular bundle and guiding the reconstruction procedure. It is a useful technique for functional surgery.

Key words: Digital guide, Inferior alveolar neurovascular bundle, Mandible reconstruction

黄栋, 何冬梅, 杨驰, 陈敏洁, 袁建兵, 白果, 陈琢之. 数字化导板在下颌骨良性病变截骨并保存下牙槽神经血管束中的应用：附1例报告[J]. 中国口腔颌面外科杂志, 2014, 12(1): 45-50.

HUANG Dong, HE Dong-mei, YANG Chi, CHEN Min-jie, YUAN Jian-bing, BAI Guo, CHEN Zhuo-zhi. Application of digital guide in the osteotomy of benign lesions in mandible with preservation of the inferior alveolar neurovascular bundle: report of one case[J]. China J Oral Maxillofac Surg, 2014, 12(1): 45-50.

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