Method for reconstructing mandible through ilium repair

Abstract

The invention discloses a method for reconstructing a mandible through ilium repair, which comprises the following specific steps of: 1, reconstructing a three-dimensional model of the mandible and the ilium of a patient, and diagnosing and determining a focus part; step 2, determining a cutting area; step 3, fitting the ilium: determining a first osteotomy area and a second osteotomy area; 4, manufacturing an ilium osteotomy guide plate, a jaw bone shaping guide plate and a jaw bone osteotomy guide plate according to the shapes of the cutting area, the first osteotomy area and the second osteotomy area; 5, the focus part on the lower jawbone of the patient is cut off through a jawbone osteotomy guide plate, the whole osteotomy area on the ilium is cut off through an ilium osteotomy guide plate, the first bone tissue is transplanted into the cut-off area on the lower jawbone of the patient, and the second bone tissue is transplanted to the lower jaw angle position on the lower jawbone of the patient; according to the invention, the missing mandibular angle part on the mandibular angle can be accurately repaired, the postoperative facial form is well recovered, and the beauty of the postoperative face is improved.

Description

Technical Field

[0001] The invention relates to the field of medical technology, and in particular to a method for reconstructing a mandible through iliac repair. Background Art

[0002] The mandible is the only movable bone in the maxillofacial region, and is of great significance to physiological functions such as pronunciation, swallowing, and chewing. Tumor surgery, trauma, infection, radioactive jaw osteonecrosis, and jaw osteonecrosis caused by bisphosphonates are important causes of mandibular defects. If the defect is small, it will have little effect on the facial appearance and function. If the defect is too large, repair and reconstruction are required.

[0003] As microvascular technology matures, the blood vessels carried by vascularized bone flaps can be anastomosed with the blood vessels in the implanted area, with stable blood supply and strong healing ability. They are gradually used to repair various soft tissue and bone defects in the mandible, including simple bone defects, complex bone defects formed by simultaneous defects of soft tissue and bone tissue, and complete removal of soft tissue and bone tissue. The success rate of vascularized bone flaps can exceed 90% when the surgical technology is mature.

[0004] The vascularized bone flaps commonly used for mandibular repair include vascularized fibula, vascularized iliac bone and vascularized scapula.

[0005] Compared with other bone flaps, vascularized iliac bone has unique advantages: 1. The curvature of the iliac crest of the iliac bone is similar to the outer edge of the mandible. It can be used as a donor bone to repair mandibular defects and obtain a satisfactory appearance. 2. The thickness of the iliac wing is similar to that of the mandibular body. The length of bone that can be taken from the anterior superior iliac spine to the back is 10-12 cm. The amount of bone provided can restore the length and height of the mandible and successfully complete the implantation. 3. The anatomy of the deep circumflex iliac artery and vein is relatively constant, the vascular pedicle is relatively long, and the vascular diameter is large, which is convenient for vascular anastomosis. The deep circumflex iliac artery has a constant ascending branch that supplies the internal oblique muscle, so that the bone flap can carry muscle tissue, and its musculocutaneous perforator supplies the skin on the surface of the iliac bone, so that the bone flap can also carry skin tissue, and repair complex defects including soft tissue in one stage. 4. The donor area of ​​the iliac bone flap can be concealed by clothes, and many complications can be avoided through good surgical operation, which can obtain the recognition and satisfaction of patients.

[0006] However, since the mandibular angle of the mandible is a convex structure and the iliac crest of the ilium is arc-shaped, the existing mandibular repair and reconstruction technology is to cut bone tissue from the iliac crest of the ilium and transplant it to the mandible. It is unable to perfectly repair and reconstruct the shape of the mandibular angle, resulting in a lack of shape at the mandibular angle position, causing left and right asymmetry of the mandibular angle of the face after surgery, and affecting the beauty of the image. Summary of the invention

[0007] The purpose of the present invention is to solve the deficiencies of the prior art and provide a method for reconstructing the mandible through iliac bone repair.

[0008] The objective of the present invention is achieved through the following technical solution: A method for reconstructing the mandible through iliac repair, comprising the following specific steps:

[0009] Step 1: Obtain CT images of the patient's mandible, reconstruct a three-dimensional model of the patient's mandible and ilium through computer software, and diagnose and determine the location of the lesion;

[0010] Step 2: Determine the resection area: Edit the three-dimensional model of the mandible through computer software, and determine the resection area on the three-dimensional model of the mandible according to the location of the lesion while retaining the safety area;

[0011] Step 3, fitting the ilium: import the three-dimensional model of the mandible and the bone tissue morphology model of the ilium into the design software, overlap the iliac crest part on the three-dimensional model of the ilium with the cut-off area on the three-dimensional model of the mandible, compare the outer edge morphology of the iliac crest part with the morphology of the cut-off area, and adjust the relative position between the three-dimensional model of the mandible and the three-dimensional model of the ilium, so that the iliac crest part completely covers the part of the cut-off area on the mandible except the mandibular angle; determine the part of the iliac crest part overlapping with the cut-off area as the first osteotomy area;

[0012] Extracting a three-dimensional model of the mandibular angle that cannot be covered by the iliac crest portion in the cut-off area, adding a second osteotomy area on the iliac crest portion of the ilium, the shape of the second osteotomy area being consistent with the shape of the mandibular angle that cannot be covered by the iliac crest portion in the cut-off area, adjusting the position of the second osteotomy area to be adjacent to the first osteotomy area, so that the first osteotomy area and the second osteotomy area form an integral osteotomy area;

[0013] Step 4: according to the shapes of the cut-off area, the first osteotomy area, and the second osteotomy area, an iliac osteotomy guide plate, a mandibular shaping guide plate, and a mandibular osteotomy guide plate are manufactured;

[0014] Step 5. Use the mandibular osteotomy guide to cut off the lesion on the patient's mandible, use the iliac osteotomy guide to cut off the entire osteotomy area on the ilium, and then divide the cut bone tissue into a first osteotomy tissue corresponding to the first osteotomy area and a second osteotomy tissue corresponding to the second osteotomy area, transplant the first osteotomy tissue to the cut-off area on the patient's mandible, transplant the second osteotomy tissue to the mandibular angle position on the patient's mandible, and shape the second osteotomy tissue and the second osteotomy tissue using the mandibular shaping guide.

[0015] Preferably, in step one, the three-dimensional models of the mandible and ilium are reconstructed using mimics 17 design software.

[0016] Preferably, in step 2, the three-dimensional model of the mandible is edited by magics design software.

[0017] Preferably, in step three, the long side of the second osteotomy area is in close contact with a side edge of the first osteotomy area.

[0018] Preferably, in step five, when the lesion site on the mandible is removed, if the patient's teeth fall into the removal area, the teeth falling into the removal area are first extracted; the distance between the edge of the removal area and the condylar neck is 8-10 mm.

[0019] Preferably, in step three, when determining the first osteotomy area, the outer edge of the iliac crest portion of the ilium is used as the boundary of one side of the first osteotomy area.

[0020] The beneficial effects of the present invention are:

[0021] 1. The present invention can accurately repair the missing mandibular angle part on the mandibular angle, and the facial morphology is well restored after the operation, thereby improving the aesthetics of the face after the operation.

[0022] 2. The present invention uses three-dimensional model reconstruction technology and the fitting of the mandibular three-dimensional model and the ilium three-dimensional model to accurately and reasonably plan the osteotomy area on the ilium, thereby reducing damage to the ilium. BRIEF DESCRIPTION OF THE DRAWINGS

[0023] Figure 1 Schematic diagram of the mandibular 3D model reconstructed using mimics 17 design software.

[0024] Figure 2 Schematic diagram of the 3D model of the ilium reconstructed using mimics 17 design software.

[0025] Figure 3 Schematic diagram of determining the resection area on the mandibular 3D model.

[0026] Figure 4 Schematic diagram of fitting the ilium three-dimensional model with the mandibular three-dimensional model.

[0027] Figure 5 Schematic diagram for determining the first osteotomy area on the ilium.

[0028] Figure 6 Schematic diagram for determining the first osteotomy area and the second osteotomy area on the ilium.

[0029] Figure 7 Schematic diagram of the second osteotomy tissue that was removed.

[0030] Figure 8 This is a schematic diagram of the removal of the lesion on the patient's mandible using a mandibular osteotomy guide.

[0031] Fig. 9 Schematic diagram of the iliac osteotomy operation using the iliac osteotomy guide.

[0032] Fig.10 Schematic diagram of mandibular shaping using a jaw shaping guide.

[0033] In the figure: 1. mandible, 2. ilium, 3. resection area, 4. condylar neck, 5. first osteotomy area, 6. mandibular angle, 7. second osteotomy area, 8. second osteotomy tissue, 10. mandibular osteotomy guide, 11. iliac osteotomy guide, 12. mandibular shaping guide. DETAILED DESCRIPTION

[0034] The following will be combined with the accompanying drawings in the embodiments of the present invention to clearly and completely describe the technical solutions in the embodiments of the present invention. Obviously, the described embodiments are only part of the embodiments of the present invention, not all of the embodiments. Based on the embodiments of the present invention, all other embodiments obtained by ordinary technicians in this field belong to the scope of protection of the present invention.

[0035] Those skilled in the art should understand that, in the disclosure of the present invention, the orientation or position relationship indicated by the terms "longitudinal", "lateral", "up", "down", "front", "back", "left", "right", "vertical", "horizontal", "top", "bottom", "inside", "outside", etc. are based on the orientation or position relationship shown in the drawings, which are only for the convenience of describing the present invention and simplifying the description, and do not indicate or imply that the device or element referred to must have a specific orientation, be constructed and operate in a specific orientation. Therefore, the above terms should not be understood as limiting the present invention.

[0036] It is to be understood that the term "one" should be understood as "at least one" or "one or more", that is, in one embodiment, the number of an element may be one, while in another embodiment, the number of the element may be multiple, and the term "one" should not be understood as a limitation on the quantity.

[0037] like Figure 1-10 As shown, a method for repairing and reconstructing a mandible 1 by using an ilium 2 comprises the following specific steps:

[0038] Step 1: Obtain a CT image of the patient's mandible 1, reconstruct a three-dimensional model of the patient's mandible 1 and ilium 2 through computer software, and diagnose and determine the location of the lesion. In this step, the computer software used is mimics 17 design software, and the three-dimensional model of the mandible 1 and ilium 2 is reconstructed through mimics 17 design software, such as Figure 1 and Figure 2 shown.

[0039] Step 2: Determine the resection area 3: Edit the three-dimensional model of the mandible 1 through computer software, and determine the resection area 3 on the three-dimensional model of the mandible 1 according to the lesion site while retaining the safety area.

[0040] In this step, the bone tissue morphology model of the mandible 1 is edited by magics design software, such as Figure 3 shown.

[0041] Step 3, fitting the ilium 2: the three-dimensional model of the mandible 1 and the bone tissue morphology model of the ilium 2 are simultaneously imported into the computer software, the computer software used is magics design software; in the design software, the iliac crest part on the three-dimensional model of the ilium 2 is overlapped with the cut-off area 3 on the three-dimensional model of the mandible 1, the outer edge morphology of the iliac crest part is compared with the morphology of the cut-off area 3, and the relative position between the three-dimensional model of the mandible 1 and the three-dimensional model of the ilium 2 is adjusted, so that the iliac crest part completely covers the cut-off area 3 on the mandible 1 except the mandibular angle 6, as shown in FIG. Figure 4 As shown; the portion of the iliac crest portion overlapping with the cut-off area 3 is determined as the first osteotomy area 5; wherein, when determining the first osteotomy area 5, the outer edge of the iliac crest portion on the ilium 2 is used as the boundary of one side of the first osteotomy area 5, so that the first osteotomy area 5 is as close as possible to the outer side of the iliac crest portion on the ilium 2 to avoid damaging the central area of ​​the ilium 2, as shown in FIG. Figure 5 shown.

[0042] A three-dimensional model of the mandibular angle 6 that cannot be partially covered by the iliac crest in the cut-off area 3 is extracted, and a second osteotomy area 7 is added to the iliac crest part of the ilium 2. The shape of the second osteotomy area 7 is consistent with the shape of the mandibular angle 6 that cannot be partially covered by the iliac crest in the cut-off area 3. The position of the second osteotomy area 7 is adjusted to be adjacent to the first osteotomy area 5, so that the first osteotomy area 5 and the second osteotomy area 7 form an integral osteotomy area. At the same time, the long side of the second osteotomy area 7 is closely attached to one side edge of the first osteotomy area 5, as shown in FIG. Figure 6 The first osteotomy area 5 and the second osteotomy area 7 are combined into an integral osteotomy area, which can reduce the number of osteotomies in subsequent operations. All the required bone tissues can be cut off in one osteotomy, and the cut area is more concentrated, which reduces the damage to the ilium 2.

[0043] Step 4: according to the shapes of the cut-off area 3 , the first osteotomy area 5 , and the second osteotomy area 7 , an iliac osteotomy guide plate 11 , a mandibular shaping guide plate 12 , and a mandibular osteotomy guide plate 10 are manufactured.

[0044] Step 5: The lesion on the mandibular bone 1 of the patient is cut off by the mandibular osteotomy guide plate 10; when the lesion on the mandibular bone 1 is cut off, if the patient's teeth fall into the cut-off area 3, the teeth falling into the cut-off area 3 are first extracted; the distance between the edge of the cut-off area 3 and the condylar neck 4 is 8-10 mm, such as Figure 8 As shown;

[0045] The entire osteotomy area on the ilium 2 is cut off by the ilium osteotomy guide plate 11, and the cut bone tissue is then divided into a first osteotomy tissue corresponding to the first osteotomy area 5 and a second osteotomy tissue 8 corresponding to the second osteotomy area 7. Figure 7 and Fig. 9 As shown, Figure 7 That is, the separated second osteotomy tissue 8, which is used to repair the mandibular angle area of ​​the patient;

[0046] After trimming and polishing the first and second osteotomy tissues 8 to match the contour of the patient's mandible 1, the first osteotomy tissue is transplanted to the cut-off area 3 on the patient's mandible 1, and the second osteotomy tissue 8 is transplanted to the mandibular angle 6 on the patient's mandible 1. The second osteotomy tissue 8 and the second osteotomy tissue 8 are fixed and shaped by the mandibular shaping guide plate 12, as shown in FIG. Fig.10 shown.

[0047] The present invention has the following advantages:

[0048] 1. The present invention can accurately repair the missing mandibular angle part on the mandibular angle, and the facial morphology is well restored after the operation, thereby improving the aesthetics of the face after the operation.

[0049] 2. The present invention uses three-dimensional model reconstruction technology and the fitting of the mandibular three-dimensional model and the ilium three-dimensional model to accurately and reasonably plan the osteotomy area on the ilium, thereby reducing damage to the ilium.

[0050] However, since the mandibular angle of the mandible is a convex structure and the iliac crest of the ilium is arc-shaped, the existing mandibular repair and reconstruction technology is to cut bone tissue from the iliac crest of the ilium and transplant it to the mandible. It is unable to perfectly repair and reconstruct the shape of the mandibular angle, resulting in a lack of shape at the mandibular angle position, causing left and right asymmetry of the mandibular angle of the face after surgery, and affecting the beauty of the image.

[0051] The present invention is not limited to the above-mentioned optimal implementation mode. Anyone can derive other various forms of products under the inspiration of the present invention. However, no matter what changes are made in the shape or structure, all technical solutions that are the same or similar to those of the present application fall within the protection scope of the present invention.

Claims

1. A method for reconstructing the mandible by repairing the iliac bone, It is characterized in that The specific steps include: Step 1: Obtain CT images of the patient's mandible, reconstruct a three-dimensional model of the patient's mandible and ilium through computer software, and diagnose and determine the location of the lesion; Step 2: Determine the resection area: Edit the three-dimensional model of the mandible through computer software, and determine the resection area on the three-dimensional model of the mandible according to the location of the lesion while retaining the safety area; Step 3, fitting the ilium: import the three-dimensional model of the mandible and the bone tissue morphology model of the ilium into the design software, overlap the iliac crest part on the three-dimensional model of the ilium with the cut-off area on the three-dimensional model of the mandible, compare the outer edge morphology of the iliac crest part with the morphology of the cut-off area, and adjust the relative position between the three-dimensional model of the mandible and the three-dimensional model of the ilium so that the iliac crest part completely covers the part of the cut-off area on the mandible except the mandibular angle; determine the part of the iliac crest part overlapping with the cut-off area as the first osteotomy area; Extracting a three-dimensional model of the mandibular angle that cannot be covered by the iliac crest portion in the cut-off area, adding a second osteotomy area on the iliac crest portion of the ilium, the shape of the second osteotomy area being consistent with the shape of the mandibular angle that cannot be covered by the iliac crest portion in the cut-off area, adjusting the position of the second osteotomy area to be adjacent to the first osteotomy area, so that the first osteotomy area and the second osteotomy area form an integral osteotomy area; Step 4: according to the shapes of the cut-off area, the first osteotomy area, and the second osteotomy area, an iliac osteotomy guide plate, a mandibular shaping guide plate, and a mandibular osteotomy guide plate are manufactured; Step 5. Use the mandibular osteotomy guide to cut off the lesion on the patient's mandible, use the iliac osteotomy guide to cut off the entire osteotomy area on the ilium, and then divide the cut bone tissue into a first osteotomy tissue corresponding to the first osteotomy area and a second osteotomy tissue corresponding to the second osteotomy area, transplant the first osteotomy tissue to the cut-off area on the patient's mandible, transplant the second osteotomy tissue to the mandibular angle position on the patient's mandible, and shape the second osteotomy tissue and the second osteotomy tissue using the mandibular shaping guide.

2. A method for reconstructing the mandible by repairing the iliac bone according to claim 1, It is characterized in that In step 1, the three-dimensional models of the mandible and ilium were reconstructed using mimics 17 design software.

3. A method for reconstructing the mandible by repairing the iliac bone according to claim 1, It is characterized in that In step 2, the three-dimensional model of the mandible is edited using magics design software.

4. A method for reconstructing the mandible by repairing the iliac bone according to any one of claims 1 to 3, It is characterized in that In step three, the long side of the second osteotomy area is in close contact with one side edge of the first osteotomy area.

5. A method for reconstructing the mandible by repairing the iliac bone according to any one of claims 1 to 3, It is characterized in that Step 5. When the lesion site on the mandible is removed, if the patient's teeth fall into the removal area, the teeth falling into the removal area are extracted first; the distance between the edge of the removal area and the condylar neck is 8-10 mm.

6. A method for reconstructing the mandible by repairing the iliac bone according to any one of claims 1 to 3, It is characterized in that In step three, when determining the first osteotomy area, the outer edge of the iliac crest portion of the ilium is used as the boundary of one side of the first osteotomy area.

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