南方医科大学学报

南方医科大学学报 ›› 2021, Vol. 41 ›› Issue (12): 1892-1898.doi: 10.12122/j.issn.1673-4254.2021.12.20

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数字化设计游离腓骨瓣重建下颌骨缺损的三维有限元分析

孙 悦，郭 蕴，李建成，刘 亮，杨东昆，陈 默，胡 恺   

  1. 蚌埠医学院第一附属医院口腔颌面外科，安徽 蚌埠 233004
  • 出版日期:2021-12-20 发布日期:2022-01-05

Mandibular defect reconstruction using digital design-assisted free fibula flap and three-dimensional finite element analysis of stress distribution

SUN Yue, GUO Yun, LI Jiancheng, LIU Liang, YANG Dongkun, CHEN Mo, HU Kai   

  1. Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
  • Online:2021-12-20 Published:2022-01-05

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摘要： 目的 通过三维有限元法评价术前数字化设计辅助游离腓骨瓣重建不同类型下颌骨组织缺损的临床应用价值。 方法 回顾性分析48例下颌骨缺损行游离腓骨瓣重建的病例，所有患者均为术后1年且无肿瘤复发。按术前是否行数字化设计分为实验组和对照组，根据HCL分类法将下颌骨缺损分为H、L、LCL型缺损，其中实验组H型缺损8例，L型缺损9例，LCL型缺损7例；对照组 H 型缺损 5 例，L 型缺损 10 例，LCL 型缺损 9 例。追踪随访两组患者，获得腓骨重建后的下颌骨 CT，采用 Mimics、Geomagic、Solidworks、Ansys等软件构建出三维有限元模型，对模型设置约束及载荷条件，得出应力分布结果，采用SPSS23.0软件对两组的应力分布相关指标进行数据分析。 结果 游离腓骨瓣重建下颌骨缺损后应力主要集中在双侧髁突颈部、下颌升支前后缘及腓骨后端与下颌骨连接处，下颌骨缺损越多，健侧髁突的应力越大。L型缺损中实验组健、患侧髁突颈、移植腓骨最大应力值均小于对照组，而健侧下颌角应力值较对照组有所上升，差异均具有统计学意义（P<0.05）；LCL型缺损中实验组健侧髁突颈较对照组最大应力值小，在患侧髁状突区、双侧下颌角区及腓骨区均较对照组大，差异均具有统计学意义（P<0.05）。 结论 数字化设计辅助游离腓骨瓣重建下颌骨缺损，提高了下颌骨重建精确性，达到了均匀下颌骨应力分布的效果，为下颌骨修复重建提供临床指导。

关键词: 数字化设计；下颌骨缺损；游离腓骨瓣；有限元分析

Abstract: Objective To evaluate of the clinical value of preoperative digital design-assisted free fibular flap for reconstruction of different types of mandibular tissue defects using three-dimensional finite element analysis. Methods This retrospective analysis was conducted in 48 patients undergoing reconstruction of mandibular defects following tumor resection using free fibular flaps. In 24 of the cases, digital design of free fibular flap was performed before the operation (experimental group), and the other 24 patients with digital design of the flap served as the control group. At 1 year after the surgery, the patients underwent mandibular CT examination and a 3-dimensional finite element model of the mandible was constructed using Mimics, Geomagic, Solidworks and Ansys. The stress distribution on the reconstructed mandibles with the H, L, or LCL types of defects, classified according to the HCL classification method, was determined under specific constraints and load conditions and compared between the experimental and control groups. Results The operations were completed successfully in all the patients, and none of them had tumor recurrence at 1 year after the operation. On the reconstructed mandibles using free fibular flaps, the stress was concentrated mainly on the neck of the bilateral condyle, the anterior and posterior edges of the ascending mandibular ramus, and the connection between the posterior end of the fibula and the mandible. A large size of mandibular defects caused greater stress at the contralateral condyle. For L-shaped defects, the maximum stress at the healthy and ipsilateral condyle necks and transplanted fibula were significantly lower, while the stress level at the healthy side mandibular angle was significantly greater in the experimental group than in the control group (P<0.05). For LCL type defects, the maximum stress at the contralateral condyle neck was smaller but the stress in the condyle area on the affected side, the bilateral mandibular angle area and the fibula area were all significantly greater in the experimental group than in the control group (P<0.05). Conclusion Digital design of the free fibular flap improves the accuracy of reconstruction of mandibular defects and helps to achieve uniform stress distribution on the reconstructed mandible.

Key words: digital design; mandible defects; free fibula flap; finite element analysis