Clinical Usefulness of Mandibular Reconstruction Using Custom-Made Titanium Mesh Tray and Autogenous Particulate Cancellous Bone and Marrow Harvested From Tibia and/or Ilia
Clinical Usefulness of Mandibular Reconstruction Using Custom-Made Titanium Mesh Tray and Autogenous Particulate Cancellous Bone and Marrow Harvested From Tibia and/or Ilia
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DOI：
10.1097/scs.0000000000002472
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发表时间：
2016-05-01
影响因子：
0.9
通讯作者：
Hamada, Yoshiki
中科院分区：
文献类型：
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作者：
Yamada, Hiroyuki;Nakaoka, Kazutoshi;Hamada, Yoshiki
本研究的目的是评估使用定制钛网（Ti-mesh）托盘和颗粒松质骨和骨髓（PCBM）重建下颌的有效性。连续21例接受下颌骨重建的患者参加了这项研究。其中男性13人，女性8人（平均年龄52.0岁）。基于术前计算机断层扫描数据，使用计算机软件进行虚拟现实模拟。利用三维打印机构建三维颅骨模型。托盘是定制的，由钛网板弯曲，以适应模型。从后髂骨和/或胫骨近端采集pcbm2后，将托盘固定在宿主骨上。用放射学评估重建下颌骨的新骨形成和形态。在随访期间记录每位患者的并发症。采用视觉模拟量表（VAS评分，范围0-100）评价患者术后面部轮廓的满意度。在21例患者中，有16例患者的新骨形成良好，达到了预期的放射学结果。5例患者新骨形成不足。导致骨形成不足的原因包括2例术后感染，2例Timesh托盘骨折，1例局部下龈癌复发。为了防止托盘骨折，双层Timesh托盘是有用的。患者满意度VAS平均评分为77.1分。我们的研究结果综合表明，使用定制钛网托盘和PCBM进行下颌重建在临床上是有用的。
The objective of this study was to evaluate usefulness of mandibular reconstructions using custom-made titanium mesh (Ti-mesh) tray and particulate cancellous bone and marrow (PCBM). Consecutive 21 patients who underwent mandibular reconstruction were enrolled in this study. They were 13 men and 8 women (mean age, 52.0 years). Virtual reality simulation was performed using computer software based on the preoperative computed tomography data. A 3-dimensional skull model was constructed using 3-dimensional printer. A tray was custom-made from Ti-mesh sheet bent to adapt to the model. After PCBMharvesting from posterior ilia and/or proximal tibia, the tray was fixed to the host bone. New bone formation and configuration of the reconstructed mandible were assessed radiologically. Complications were recorded in each patient during the follow-up period. Patients' satisfaction with postoperative facial contour was evaluated using visual analog scale (VAS score, range, 0-100). In 16 of 21 patients, excellent newbone formation was recognized and expected results were radiologically achieved. In 5 patients, new bone formation was insufficient. Causes of insufficient bone formation included postoperative infection in 2 patients, Timesh tray fracture in 2 patients, and local recurrence of lower gingival cancer in 1 patient. To prevent a tray fracture, a double-layered Timesh tray was useful. Mean VAS score on patients' satisfaction was 77.1. Our results comprehensively suggest that mandibular reconstruction using custom-made Ti-mesh tray and PCBM is clinically useful.