目的:尽管近年来使用腓骨皮瓣的计算机辅助手术已广泛应用于肿瘤颌骨重建,腓骨收获导轨的不准确定位会带来滑动和旋转误差,这导致植入物同时放置和牙科康复的准确性受损。这项研究旨在开发一种新颖的三维(3D)打印的患者专用腓骨踝帽,以提高肿瘤重建的准确性。
方法:在这项与最近的历史对照队列的前瞻性比较研究中,我们招募了需要使用腓骨游离皮瓣进行肿瘤颌骨重建的患者.在研究小组中,腓骨是在踝帽的引导下收获的,而在对照组中,没有踝帽.腓骨远端截骨术的位置和角度偏差,颌骨重建节段,并对同时种植牙进行了比较。
结果:招募了20名患者,每个手臂有10个。踝帽的应用显着减少了腓骨远端截骨术的位置和角度的偏差,从9.5到4.1毫米和25.3°到8.7°。对于同时放置在腓骨皮瓣中的牙科植入物,植入平台位置的准确性显着提高(平均偏差从3.2到1.3mm),顶点位置(从3.8到1.5毫米),和角度(从11.3°到4.6°)。腓骨重建节段的准确性未检测到显着差异。
结论:我们开发了一种新颖的腓骨踝帽,以克服腓骨皮瓣收获期间的滑动和旋转误差,用于肿瘤颌骨重建。同时种植牙的准确性提高。这是通过牙齿康复实现令人满意的颌骨重建功能效果的一步。
OBJECTIVE: Although computer-assisted surgery using fibula flap has been widely applied for oncologic jaw reconstruction in recent years, the inaccurate positioning of the fibula harvest guide brings sliding and rotational errors, which leads to compromised accuracy in simultaneous implant placement and dental rehabilitation. This study aimed to develop a novel three-dimensional (3D)-printed patient-specific fibula malleolus cap to increase oncologic reconstruction accuracy.
METHODS: In this prospective comparative study with a recent historical control cohort, patients in need of oncologic jaw reconstruction with fibula free flaps were recruited. In the study group, the fibula was harvested with the guide of the malleolus cap, whereas in the control group, without the malleolus cap. Deviations of location and angulation of distal fibula osteotomies, jaw reconstruction segments, and simultaneous dental implants were compared.
RESULTS: Twenty patients were recruited, with 10 in each arm. The application of the malleolus cap significantly reduced the deviations in locations and angles of distal fibula osteotomies, from 9.5 to 4.1 mm and 25.3° to 8.7°. For the simultaneous dental implants placed in the fibula flaps, there was a significant increase in the accuracy of implant platform locations (the average deviation from 3.2 to 1.3 mm), apex locations (from 3.8 to 1.5 mm), and angles (from 11.3° to 4.6°). No significant difference was detected in the accuracy of fibula reconstruction segments.
CONCLUSIONS: We developed a novel fibula malleolus cap to overcome the sliding and rotational errors during fibula flap harvesting for oncologic jaw reconstruction, with increased accuracy in simultaneous dental implants. This is a step forward to achieve a satisfactory functional outcome of jaw reconstruction with dental rehabilitation.