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北京大学学报（医学版） ›› 2020, Vol. 52 ›› Issue (1): 119-123. doi: 10.19723/j.issn.1671-167X.2020.01.019

• 论著 • 上一篇    下一篇

术前虚拟设计在股前外侧皮瓣修复口腔颌面部缺损中的应用

王顺吉1,章文博1,于尧1,谢晓艳2,杨宏宇3,彭歆1,△()   

  1. 1. 北京大学口腔医学院·口腔医院,口腔颌面外科　国家口腔疾病临床医学研究中心　口腔数字化医疗技术和材料国家工程实验室　口腔数字医学北京市重点实验室,北京　100081
    2. 北京大学口腔医学院·口腔医院医学影像科,北京　100081
    3. 北京大学深圳医院口腔医学中心,广东深圳　518036
  • 收稿日期:2019-10-14 出版日期:2020-02-18 发布日期:2020-02-20
  • 通讯作者: 彭歆 E-mail:pxpengxin@263.net
  • 基金资助:
    宁夏回族自治区东西部科技合作项目(2018BEG02012)

Application of computer-assisted design for anterolateral thigh flap in oral and maxillofacial reconstruction

Shun-ji WANG1,Wen-bo ZHANG1,Yao YU1,Xiao-yan XIE2,Hong-yu YANG3,Xin PENG1,△()   

  1. 1. Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
    2. Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology, Beijing 100081, China
    3. Center of Stomatology, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong, China
  • Received:2019-10-14 Online:2020-02-18 Published:2020-02-20
  • Contact: Xin PENG E-mail:pxpengxin@263.net
  • Supported by:
    Supported by the Key Research and Development Program of Ningxia Hui Autonomous Region(2018BEG02012)

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摘要：

目的:探讨术前数字化技术虚拟设计股前外侧皮瓣应用于口腔颌面部缺损修复重建中的可行性及精确性。方法:选择2019年6月至10月就诊于北京大学口腔医院口腔颌面外科的10例采用股前外侧皮瓣修复口腔颌面部缺损的患者。术前应用高频彩色多普勒超声对患者股前外侧皮瓣穿支进行定位,明确穿支位置;利用螺旋CT对患者下肢进行扫描,获取DICOM格式的CT数据,将之导入Proplan CMF 3.0软件,进行股前外侧皮瓣虚拟设计,并计算皮瓣体积;术中按照术前设计进行股前外侧皮瓣制备,并利用排水法对皮瓣实际体积进行测量,计算术前高频彩色多普勒超声定位的股前外侧皮瓣穿支位置与术中穿支实际穿出位置的符合率。应用配对样本t检验统计分析术前虚拟设计的股前外侧皮瓣体积与术中排水法所测得的皮瓣实际体积之间的差异。结果:术前利用彩色多普勒超声共发现皮瓣内穿支15支,术中实际发现穿支16支,总体符合率为87.5%。术前虚拟设计的股前外侧皮瓣体积与术中排水法所测得的皮瓣实际体积之间的差异无统计学意义(t=0.318,P=0.758)。结论:采用数字化技术对股前外侧皮瓣进行术前虚拟设计的方法具有良好的可行性和精确性,可用于指导术中制备股前外侧皮瓣。

关键词: 口腔颌面部重建, 股前外侧皮瓣, 数字化技术, 虚拟设计

Abstract:

Objective: To investigate the feasibility and accuracy of using digital technology to design anterolateral thigh flap (ALTF) in oral and maxillofacial defect reconstruction. Methods: Ten cases underwent oral and maxillofacial defects reconstruction with ALTFs in Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from June 2019 to Oct. 2019 were enrolled. There were 7 males and 3 females with the mean age of 47.1 years. Preoperative high frequency color Doppler ultrasound examination was performed to detect the perforators of ALTF. CT data of the thigh was imported in DICOM (digital imaging and communications in medicine) format to the Proplan CMF 3.0 software (Materalise, Belgium), then virtual harvest of ALTF was performed according to the points of perforators detected by high frequency color Doppler ultrasound and the virtual flap volume was calculated by Proplan CMF 3.0 software. ALTF was harvested followed by preoperative virtual design, and the actual flap volume of ALTF was measured by the draining method during the surgery. Finally, the accuracy rate of using high frequency color Doppler ultrasound to detect perforators of ALTFs was calculated, and the differences between the virtual flap volume measured by Propaln CMF 3.0 software and the actual volume of ALTF by the draining method were compared using paired samples T test. Results: Fifteen perforators in the flaps area of 10 patients who underwent oral and maxillofacial defects reconstruction with ALTFs were detected by high frequency color Doppler ultrasound, and 16 perforators were identified during the surgery, with the accuracy rate of 87.5%. The flaps size ranged from 5 cm×7 cm to 8 cm×15 cm, all the 10 flaps survived. The donor sites were primarily closed without skin graft, and no surgery complication was found on the donor site. The mean flap volume measured by Propaln CMF 3.0 software was 71.4 cm 3 (range: 36.1-188.4 cm 3), and the mean volume measured by the draining method was 70.7 cm 3 (range: 38.3-172.5 cm 3). There was no significant difference between the virtual flap volume measured by Propaln CMF 3.0 software and the actual volume measured by draining method (t=0.318; P=0.758). Conclusion: Preoperative virtual design of ALTF has good feasibility and accuracy and can be used to guide the harvest of ALTF during operation.

Key words: Oral and maxillofacial reconstruction, Anterolateral thigh flap, Computer-assisted design, Virtual design

中图分类号: 

  • R782.2

图1

股前外侧皮瓣术前虚拟设计及术中体积测量"

表1

10例患者的基本信息"

Case Gender Age/years Site of lesion Pathology
1 Male 39 Maxilla Chondrosarcoma
2 Female 67 Maxilla Squamous cell carcinoma
3 Male 9 Maxilla Osteosarcoma
4 Female 56 Maxilla Adenoid cystic carcinoma
5 Male 76 Maxilla Malignant fibrous histiotoma
6 Male 51 Maxilla Osteomyelitis
7 Male 44 Maxilla Osteomyelitis
8 Male 30 Tongue Squamous cell carcinoma
9 Female 52 Maxilla Ameloblastoma
10 Male 47 Tongue Squamous cell carcinoma

表2

患者术前及术中的穿支和皮瓣体积"

Case Preoperative
perforator		 Intraoperative
perforator		 Preoperative
volume/cm3		 Intraoperative
volume/cm3
1 1 1 39.9 46.7
2 1 1 36.1 38.3
3 1 1 45.0 47.1
4 1 1 40.8 42.5
5 1 1 37.4 39.4
6 2 2 61.7 59.5
7 2 2 57.1 55.0
8 1 1 188.4 172.5
9 3 4 75.4 78.0
10 2 2 131.7 128.5
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ISSN 1671-167X
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