上海口腔医学

上海口腔医学 ›› 2023, Vol. 32 ›› Issue (5): 519-524.doi: 10.19439/j.sjos.2023.05.013

• 论著 • 上一篇    下一篇

数字化精准骨穿刺指导颌骨切除范围的可行性研究

刘畅1, 吴琼2, 陈少华2, 徐涛1, 刘亮1, 张凯1   

  1. 1.蚌埠医学院第一附属医院 口腔科,安徽 蚌埠 233000;
    2.蚌埠医学院 病理教研室,安徽 蚌埠 233000
  • 收稿日期:2022-04-28 修回日期:2022-07-15 出版日期:2023-10-25 发布日期:2023-11-03
  • 通讯作者: 张凯,E-mail: zk29788@163.com
  • 作者简介:刘畅（1989-）,男,硕士,主治医师,E-mail: 402928682@qq.com
  • 基金资助:
    蚌埠医学院自然科学重点项目（2020byzd158,2020byzd038）; 安徽省高校拔尖人才培育项目（gxbjZD2021058）

Feasibility of precise digital techniques combined with bone puncture techniques to guide the extent of jaw resection

LIU Chang1, WU Qiong2, CHEN Shao-hua2, XU Tao1, LIU Liang1, ZHANG Kai1   

  1. 1. Department of Stomatology, The First Affiliated Hospital of Bengbu Medical College. Bengbu 233000;
    2. Department of Pathology, Bengbu Medical College. Bengbu 233000, Anhui Province, China
  • Received:2022-04-28 Revised:2022-07-15 Online:2023-10-25 Published:2023-11-03

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摘要： 目的：评价利用Mimics结合3D打印及骨组织穿刺活检技术指导下颌骨恶性肿瘤切除范围的可行性。方法：选择蚌埠医学院第一附属医院口腔颌面外科2019年1月—2021年4月因口腔鳞癌入院并行下颌骨切除手术的15例患者。术前取患者下颌骨CT数据,导入Mimics软件进行编辑,通过3D打印技术打印穿刺导板,测量截骨长度与损失牙数量。术后将切除的下颌骨使用穿刺导板及经皮穿刺针进行相应位点骨穿刺,并送病理检查。对下颌骨大体病理进行脱钙,待脱钙后,对同一位点进行取材,检验精确定位的骨穿刺病理相对大体脱钙病理的准确性,对比实际截骨长度与模拟截骨长度、实际缺牙数量与模拟缺牙数量。采用SPSS 17.0软件包对数据进行统计学分析。结果：利用3D导板进行的骨穿刺病理拥有和大体脱钙病理一致的准确性;模拟截骨长度显著小于实际截骨长度（P<0.001）,模拟缺牙数量显著少于实际缺牙数量（P<0.01）。结论：利用Mimics结合骨组织穿刺活检技术指导下颌骨恶性肿瘤切除范围,可以更加准确地进行下颌骨截断,从而保留更多的健康骨质及牙。

关键词: 下颌骨恶性肿瘤, 手术安全缘, 3D打印技术, 骨穿刺活检技术

Abstract: PURPOSE: To evaluate the feasibility of Mimics software combined with 3D printing and bone biopsy to guide the resection scope of mandibular malignant tumors. METHODS: Fifteen patients admitted to the Department of Oral and Maxillofacial Surgery of the First Affiliated Hospital of Bengbu Medical College from January 2019 to April 2021 for oral malignancies and requiring mandibular osteotomy were selected. Preoperatively, CT data of the mandibles were taken to design and print the puncture guide using Mimics software and 3D printing technology, and the length of the osteotomy and the number of teeth lost were also measured. The resected mandible was then combined with the puncture guide and a percutaneous puncture needle to perform bone puncture at the appropriate site and sent for pathology. The mandibular gross specimen was decalcified and when decalcified, the mandibular gross was taken from the same loci, thus testing the accuracy of the bone puncture pathology relative to the gross decalcification pathology, comparing the actual osteotomy length with the simulated osteotomy length and comparing the actual number of missing teeth with the simulated number of missing teeth. SPSS 17.0 software package was used for data analysis. RESULTS: Bone puncture pathology using 3D guides possessed consistent accuracy with gross decalcification pathology. Simulated osteotomy length was significantly less than actual osteotomy length(P<0.001). Simulated number of missing teeth was significantly less than actual number of missing teeth (P<0.01). CONCLUSIONS: The use of Mimics software combined with bone puncture biopsy techniques to guide the extent of resection of malignant tumors in the mandible allows for more accurate mandibular osteotomy, thereby preserving more healthy bone and teeth.

Key words: Malignant tumor of the mandible, Surgical safety margin, 3D printing technology, Bone puncture biopsy technique

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