PDF(Pubmed)
Abstract：
OBJECTIVE: To compare the changes in condylar position after mandibular reconstruction with free fibular flap(FFF) and the differences between computer-assisted techniques and traditional methods on CT images.
METHODS: Thirty-four patients who underwent mandibular reconstruction with free fibular flap were selected according to the inclusion and exclusion criteria. In the 3D group, virtual surgical planning (VSP) with osteotomy cutting plate and placement guiding plate were used, while the traditional group underwent freehand reconstruction. The CT data of 68 temporomandibular joints (TMJs) were recorded before and immediately after surgery. The condylar position was evaluated by measuring the anterior space (AS), posterior space (PS) and superior space (SS), and the ln (PS/AS) was calculated according to the method proposed by Pullinger and Hollender.
RESULTS: In the patients included in the 3D group, the condyle on the ipsilateral side moved slightly backward; however, in the patients in the traditional group, the ipsilateral side moved considerably anteroinferior. No obvious changes on the contralateral side were noted. In the 3D group, 33% of ipsilateral condyles were in the posterior position postoperatively when compared with the preoperative position (13%). In the traditional group, the number of ipsilateral condyles in the anterior position increased from 4 to 10, accounting for 53% postoperatively. Contrary to the traditional group, the 3D group presented less condylar displacement on the ipsilateral side postoperatively.
CONCLUSIONS: This study showed a decreased percentage of change in condylar position postoperatively when VSP was used. Virtual surgical planning improved the accuracy of FFF mandibular reconstruction and made the condylar position more stable.
METHODS: Thirty-four patients who underwent mandibular reconstruction with free fibular flap were selected according to the inclusion and exclusion criteria. In the 3D group, virtual surgical planning (VSP) with osteotomy cutting plate and placement guiding plate were used, while the traditional group underwent freehand reconstruction. The CT data of 68 temporomandibular joints (TMJs) were recorded before and immediately after surgery. The condylar position was evaluated by measuring the anterior space (AS), posterior space (PS) and superior space (SS), and the ln (PS/AS) was calculated according to the method proposed by Pullinger and Hollender.
RESULTS: In the patients included in the 3D group, the condyle on the ipsilateral side moved slightly backward; however, in the patients in the traditional group, the ipsilateral side moved considerably anteroinferior. No obvious changes on the contralateral side were noted. In the 3D group, 33% of ipsilateral condyles were in the posterior position postoperatively when compared with the preoperative position (13%). In the traditional group, the number of ipsilateral condyles in the anterior position increased from 4 to 10, accounting for 53% postoperatively. Contrary to the traditional group, the 3D group presented less condylar displacement on the ipsilateral side postoperatively.
CONCLUSIONS: This study showed a decreased percentage of change in condylar position postoperatively when VSP was used. Virtual surgical planning improved the accuracy of FFF mandibular reconstruction and made the condylar position more stable.
摘要：
目的：比较游离腓骨皮瓣（FFF）下颌骨重建后髁突位置的变化以及计算机辅助技术与传统方法在CT图像上的差异。
方法：根据纳入和排除标准，选择34例采用腓骨游离皮瓣行下颌骨重建的患者。在3D组中，采用截骨切割板和放置引导板的虚拟手术计划(VSP),而传统组进行了徒手重建。记录手术前后68个颞下颌关节（TMJs）的CT数据。通过测量前间隙（AS）评估髁突位置，后空间（PS）和上空间（SS），并根据Pullinger和Hollender提出的方法计算ln(PS/AS)。
结果：在3D组中包括的患者中，同侧的髁向后轻微移动；然而，在传统组的患者中，同侧前下移动相当大。对侧无明显变化。在3D组中，与术前位置相比，术后33％的同侧髁位于后部位置（13％）。在传统群体中,前位同侧髁的数量从4个增加到10个，占术后的53％。与传统群体相反，3D组术后同侧髁突移位较少。
结论：本研究显示，当使用VSP时，术后髁突位置变化的百分比降低。虚拟手术计划提高了FFF下颌骨重建的准确性，使髁突位置更加稳定。
方法：根据纳入和排除标准，选择34例采用腓骨游离皮瓣行下颌骨重建的患者。在3D组中，采用截骨切割板和放置引导板的虚拟手术计划(VSP),而传统组进行了徒手重建。记录手术前后68个颞下颌关节（TMJs）的CT数据。通过测量前间隙（AS）评估髁突位置，后空间（PS）和上空间（SS），并根据Pullinger和Hollender提出的方法计算ln(PS/AS)。
结果：在3D组中包括的患者中，同侧的髁向后轻微移动；然而，在传统组的患者中，同侧前下移动相当大。对侧无明显变化。在3D组中，与术前位置相比，术后33％的同侧髁位于后部位置（13％）。在传统群体中,前位同侧髁的数量从4个增加到10个，占术后的53％。与传统群体相反，3D组术后同侧髁突移位较少。
结论：本研究显示，当使用VSP时，术后髁突位置变化的百分比降低。虚拟手术计划提高了FFF下颌骨重建的准确性，使髁突位置更加稳定。
