实时术中计算机断层扫描在虚拟手术计划双筒腓骨瓣重建中产生了小于1mm偏差的精度,这是数字OR中智能技术的共生。
随着虚拟手术计划的智能技术,CAD/CAM,术中CT(iCT)的数字OR,采用双筒腓骨修复下颌骨继发性缺损或原发性下颌骨缺损,达到精准医学目的。
一系列7例口腔癌患者接受了5例骨坏死的游离皮瓣,2节段性下颌骨缺损,和2个成釉细胞瘤。他们接受了9个双桶腓骨皮瓣和2个自由皮肤皮瓣转移。腓骨皮瓣使用虚拟手术计划进行重建,包括用于模拟3D模型的CAD/CAM,受体部位和腓骨截骨术的切割指南,和iCT用于数字OR中的图像融合。
下颌骨缺损5~16cm,平均9.56cm,和2-5腓骨支柱用于双桶腓骨(平均:3.67个支柱)图像融合。需要进行一次动脉静脉移植,所有11个皮瓣均成功转移,无需重新探查。6例患者术中对腓骨和钢板进行了翻修,以将图像融合体积从74.71%提高到82.57%。5例患者术后切牙中线偏离小于2mm,4例无牙患者的还原图像。包括双侧髁在内的五个地标,双侧性腺,和gnathion表现出平均偏差小于1毫米。
CAD/CAM可以允许实际的虚拟手术使用双筒腓骨恢复下颌骨缺损重建。数字OR中智能技术的共生,iCT可以提高下颌空间框架和咬合平片的准确性。
Real-time intraoperative computed tomography created the accuracy of less than 1 mm deviation in virtual surgical planning double barrel fibular flap for mandibular reconstruction-the symbiosis of intelligent technology in a digital OR.
With the intelligent technology of virtual surgical planning, CAD/CAM, and intraoperative CT(iCT) in a digital OR, the secondary mandibular defect or primary amelobalstoma mandibulectomy can be restored using double barrel fibula and be achieved precision medicine purpose.
A series of 7 patients underwent free flap for oral cancers who sustained 5 osteoradionecrosis, 2 segmental mandibular defect, and 2 ameloblastoma. They received 9 double barrel fibula flap and 2 free skin flaptransfers. The fibula flap were reconstructed using a virtual surgical planning including CAD/CAM for simulation 3D model, cutting guides for recipient sites and fibulas osteotomy, and iCT for image fusion in a digital OR.
The mandibular defect was 5-16 cm (average: 9.56 cm), and 2-5 fibular struts for double barrel fibula (average: 3.67 struts) image fusion. One vein graft for artery was required and all 11 flaps were transferred successfully without reexploration. Six patients had intraoperative revision of the fibula and plate to improve the onlay image fusion volume from 74.71 to 82.57%. The postoperative inter-incisor midline deviation was less than 2 mm in 5 patients, and well reduction image in 4 edentulous patients. Five landmarks including bilateral condyles, bilateral gonions, and gnathion demonstrated deviation less than 1 mm in average.
CAD/CAM can allow a practical virtual surgery to restore mandibular defect reconstruction using a double barrel fibula. The symbiosis of intelligent technology in a digital OR, the iCT can promote the accuracy of mandibular spatialframework and occlusion plain.