计算机导航技术在下颌骨成釉细胞瘤切除及修复重建手术中的应用探讨

doi:10.13591/j.cnki.kqyx.2023.01.011

摘要/Abstract

摘要： 目的利用计算机导航技术指导下颌骨成釉细胞瘤病灶切除手术及修复重建,评价其治疗效果。方法选择南京大学医学院附属口腔医院,南京市口腔医院口腔颌面外科2017年1月—2022年5月就诊的患者12例,均在病灶切除同时同期完成血管化腓骨移植,其中,导航组手术6例,非导航组手术6例,评价计算机导航技术在该术式中的利弊。结果 12例手术均为同一名术者完成,导航组固定导航支架及实施导航平均时间约15 min,相较于非导航组,导航组平均手术时间缩短约10 min,手术切除范围与腓骨修复重建匹配度高,术后咬合关系恢复良好。结论利用下颌骨参考架,在计算机导航技术引导下实施下颌骨成釉细胞瘤切除及修复重建手术,可以使手术快速、精准地完成。

关键词: 计算机导航技术, 成釉细胞瘤, 下颌骨参考架, 实时导航

Abstract: Objective Using computer-assisted navigation technology to guide the resection and reconstruction of mandibular ameloblastoma, evaluating its treatment effect. Methods Twelve patients were selected from the Affiliated Stomatological Hospital of Nanjing University from January 2017 to May 2022. All 12 patients accepted same surgery which included resection of mandibular ameloblastoma and reconstruction by fibula musculocutaneous flap. Among them, 6 cases were included in the navigation group; 6 cases were in the non-navigation group. Advantages and disadvantages of computer-assisted navigation technology in this operation were evaluated with these cases. Results The 12 operations were performed by the same operator. The average time for fixing the navigation bracket and performing navigation in the navigation group was about 15 minutes. Compared with the non-navigation group, the average operation time in the navigation group was shortened by about 10 minutes. In the navigation group, the mandible resection range matched the fibula musculocutaneous flap well, and the occlusal relationship recovered well. Conclusion Using the mandibular reference frame, under the guidance of computer-assisted navigation technology, the resection and reconstruction of mandibular ameloblastoma can be performed quickly and accurately.

Key words: computer-assisted navigation technology, ameloblastoma, mandibular reference frame, real-time navigation

中图分类号:

R739.82

刘敏, 唐恩溢, 刘喆, 葛苏蒙, 吴朱昊, 张兴伟, 孙国文. 计算机导航技术在下颌骨成釉细胞瘤切除及修复重建手术中的应用探讨[J]. 口腔医学, 2023, 43(1): 62-69.

LIU Min, TANG Enyi, LIU Zhe, GE Sumeng, WU Zhuhao, ZHANG Xingwei, SUN Guowen. Application of computer-assisted navigation technology in the resection and reconstruction of mandibular ameloblastoma[J]. Stomatology, 2023, 43(1): 62-69.

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病例	性别	年龄 /岁	诊断	病灶部位	CT检查测量最大截面范围/(cm×cm)	影像资料典型表现
1	女	39	左下颌骨成釉细胞瘤	下颌骨体部	2.9×2.7	颌骨颊舌向膨隆,呈类圆形多房囊性骨质吸收
2	男	28	右下颌骨成釉细胞瘤	下颌骨体部及升支	3.9×3.1	颌骨颊舌向膨隆,累及牙齿牙根呈截根样吸收
3	女	66	左下颌骨成釉细胞瘤	下颌骨体部	3.5×2.2	颌骨颊舌向膨隆,呈多房大小不等囊性及蜂窝状低密度影
4	男	30	右下颌骨成釉细胞瘤	下颌骨体部	4.5×2.7	颌骨颊舌向膨隆,呈类圆形多房囊性骨质吸收,累及牙根呈截根状、锯齿状吸收及移位
5	女	66	左下颌骨成釉细胞瘤	下颌角(体部及升支)	3.1×1.3	颌骨内多房大小不等囊性及蜂窝状低密度影
6	男	45	右下颌骨成釉细胞瘤	下颌角(体部及升支)	3.6×3.2	44、45牙根截根样吸收,颌骨颊舌向膨隆,呈多房囊性骨质吸收
7	男	34	右下颌骨成釉细胞瘤	下颌骨体部及升支前缘	4.2×3.8	颌骨呈多房囊性骨质吸收,颊舌向膨隆明显
8	女	50	左下颌骨成釉细胞瘤	下颌骨体部	3.5×2.5	33—36牙根呈截根样吸收
9	男	56	右下颌骨成釉细胞瘤	下颌骨体部	3.6×2.4	46牙根截根样吸收,46至下颌升支前缘呈多房囊性骨质吸收
10	男	36	右下颌骨成釉细胞瘤	下颌骨体部及升支前缘	4.8×3.5	右下颌后牙至磨牙后区见多房囊性骨质吸收,颊舌向膨隆明显
11	女	40	左下颌骨成釉细胞瘤	下颌骨体部及升支	2.7×3.8	颌骨颊舌向膨隆,多房大小不等囊性低密度影,37呈截根样吸收
12	女	42	左下颌骨成釉细胞瘤	下颌骨体部及升支	4.6×2.9	颌骨颊舌向膨隆,下颌骨神经管受推下移,37、38呈截根样吸收