两种血管化游离骨移植修复下颌骨缺损的回顾性研究

doi:10.13701/j.cnki.kqyxyj.2024.12.005

口腔医学研究 ›› 2024, Vol. 40 ›› Issue (12): 1059-1064.DOI: 10.13701/j.cnki.kqyxyj.2024.12.005

两种血管化游离骨移植修复下颌骨缺损的回顾性研究

周旺¹, 吕伟华¹, 王希乾², 仝春实², 武洋², 彭利伟^2*

1.河南大学口腔医学院河南郑州 450000;
2.河南省人民医院口腔颌面外科河南郑州 450000

收稿日期:2024-04-22 出版日期:2024-12-28 发布日期:2024-12-23
通讯作者: *彭利伟,E-mail:pengliw2003@aliyun.com
作者简介:周旺(1996~ ),男,江西九江人,硕士在读,研究方向:游离皮瓣移植。

Retrospective Comparative Study of Two Types of Vascularized Free Bone Transplantation for Repairing Mandibular Defects

ZHOU Wang¹, LV Weihua¹, WANG Xiqian², TONG Chunshi², WU Yang², PENG Liwei^2*

1. Henan University School of Stomatology, Zhengzhou 450000, China;
2. Department of Oral and Maxillofacial Surgery, Henan Provincial People's Hospital, Zhengzhou 450000, China

Received:2024-04-22 Online:2024-12-28 Published:2024-12-23

摘要/Abstract

摘要： 目的: 总结分析我院口腔颌面外科近几年收治的因各种原因导致下颌骨缺损的病例,比较血管化游离腓骨瓣和髂骨瓣的优缺点及临床效果。方法: 回顾性分析比较血管化游离腓骨瓣及髂骨瓣修复下颌骨缺损的适应证、围手术期信息和预后情况。结果: 27例腓骨瓣及32例髂骨瓣均成活,两者在一般资料、面部外形和功能恢复(术后6个月后)方面比较无明显差异,在下颌骨缺损类型和长度、手术时间、ICU住院时间、术后住院时间上比较明显不同。结论: 下颌角处缺损优先考虑血管化游离髂骨瓣修复,跨越中线的缺损优先考虑血管化游离腓骨瓣修复,Brown分类方法能够很好指导骨瓣选择的类型。缺损大于90 mm优先考虑腓骨修复,且可以同时携带皮岛修复软组织缺损,小于90 mm不伴有软组织缺损优先考虑髂骨修复,小于90 mm伴有软组织缺损携带阔筋膜张肌瓣修复。血管化游离髂骨瓣在手术时间、ICU住院时间及术后住院时间明显优于血管化游离腓骨瓣。血管化游离腓骨瓣和髂骨瓣均能很好地恢复患者面部外形和口腔功能,且无明显差异。

关键词: 血管化游离腓骨瓣, 血管化游离髂骨瓣, 下颌骨缺损, 修复重建外科, 功能及外形评价

Abstract: Objective: To summarize and analyze the cases of mandibular defects caused by various reasons in the maxillofacial surgery team of our hospital in recent years, and compare the advantages, disadvantages, and clinical effects between vascularized free fibular flap and iliac flap. Methods: A retrospective study was conducted on 59 cases of vascularized free fibular and iliac flaps for repairing mandibular defects. The indications, perioperative information, and prognosis of vascularized free fibular and iliac flaps for repairing mandibular defects were evaluated and compared. Results: Twenty-seven cases of fibular flap and 32 cases of iliac flap survived, and there was no significant difference in general information, facial appearance, and oral function recovery (6 months after surgery) between two groups. There were significant differences in the type and length of mandibular defect, surgical time, ICU hospitalization time, and postoperative hospitalization time. Conclusion: For mandibular angle defects, vascularized free iliac flap repair is prioritized, while for defects crossing the midline, vascularized free fibular flap repair is prioritized. The Brown classification method can effectively guide the selection of bone flap types. For defects larger than 90 mm, priority should be given to fibular repair, and skin islands can be carried simultaneously to repair soft tissue defects. For defects smaller than 90 mm without soft tissue defects, priority should be given to iliac bone repair. For defects smaller than 90 mm with soft tissue defects, tensor fascia lata flap should be carried for repair. The vascularized free iliac flap is significantly better than the vascularized free fibular flap in terms of surgical time, ICU hospital stay, and postoperative hospital stay. Both vascularized free fibular and iliac flaps can effectively restore the patient's facial appearance and oral function without significant differences.

Key words: vascularized free fibular flap, vascularized free iliac bone flap, mandible defect, repair and reconstruction surgery, function and appearance evaluation

周旺, 吕伟华, 王希乾, 仝春实, 武洋, 彭利伟. 两种血管化游离骨移植修复下颌骨缺损的回顾性研究[J]. 口腔医学研究, 2024, 40(12): 1059-1064.

ZHOU Wang, LV Weihua, WANG Xiqian, TONG Chunshi, WU Yang, PENG Liwei. Retrospective Comparative Study of Two Types of Vascularized Free Bone Transplantation for Repairing Mandibular Defects[J]. Journal of Oral Science Research, 2024, 40(12): 1059-1064.

参考文献

[1] Davudov MM, Harirchi I, Arabkheradmand A, et al. Evaluation of quality of life in patients with oral cancer after mandibular resection: Comparing no reconstruction, reconstruction with plate, and reconstruction with flap[J]. Medicine(Baltimore), 2019, 98(41): e17431.
[2] Kumar BP, Venkatesh V, Kumar KA, et al. Mandibular reconstruction: Overview[J]. J Maxillofac Oral Surg, 2016, 15(4): 425-441.
[3] Bowerman JE. A review of reconstruction of the mandible[J]. Proc R Soc Med, 1974, 67(7): 610-614.
[4] Foster RD, Anthony JP, Sharma A, et al. Vascularized bone flaps versus nonvascularized bone grafts for mandibular reconstruction: an outcome analysis of primary bony union and endosseous implant success[J]. Head Neck, 1999, 21(1): 66-71.
[5] Torroni A, Marianetti TM, Romandini M, et al. Mandibular reconstruction with different techniques[J]. J Craniofac Surg, 2015, 26(3): 885-890.
[6] van Gemert JTM, Abbink JH, van Es RJJ, et al. Early and late complications in the reconstructed mandible with free fibula flaps[J]. J Surg Oncol, 2018, 117(4): 773-780.
[7] 秦帅华,李新明,李文鹿.游离腓骨肌皮瓣修复下颌骨成釉细胞瘤术后患者生存质量及其医学特征相关性研究[J].临床口腔医学杂志,2018,34(3): 153-156.
[8] Hayden RE, Mullin DP, Patel AK. Reconstruction of the segmental mandibular defect: current state of the art[J]. Curr Opin Otolaryngol Head Neck Surg, 2012, 20(4): 231-236.
[9] Sarkar SK, Lee BT. Hard tissue regeneration using bone substitutes: an update on innovations in materials[J]. Korean J Intern Med, 2015, 30(3): 279-293.
[10] Yu Y, Zhang WB, Liu XJ, et al. Double-barrel fibula flap versus vascularized iliac crest flap for mandibular reconstruction[J]. J Oral Maxillofac Surg, 2020, 78(5): 844-850.
[11] Ulkur E, Karagoz H, Kulahci Y, et al. One-and-a-half-barrel vascularized free fibular flap for the reconstruction of segmental mandibular defect[J]. J Craniofac Surg, 2013, 24(2): e167-e169.
[12] 毛驰,俞光岩,彭歆,等.腓骨复合瓣游离移植修复下颌骨缺损[J].中国修复重建外科杂志,2002,16(2): 114-116.
[13] 夏德林,付光新,马征,等.腹内斜肌-髂骨复合组织瓣修复半侧下颌骨缺损[J].中华整形外科杂志,2015,31(2): 85-88.
[14] Moscoso JF, Keller J, Genden E, et al. Vascularized bone flaps in oromandibular reconstruction. A comparative anatomic study of bone stock from various donor sites to assess suitability for enosseous dental implants[J]. Arch Otolaryngol Head Neck Surg, 1994, 120(1): 36-43.
[15] Mücke T, Loeffelbein DJ, Kolk A, et al. Comparison of outcome of microvascular bony head and neck reconstructions using the fibular free flap and the iliac crest flap[J]. Br J Oral Maxillofac Surg, 2013, 51(6): 514-519.
[16] Wilkman T, Husso A, Lassus P. Clinical comparison of scapular, fibular, and iliac crest osseal free flaps in maxillofacial reconstructions[J]. Scand J Surg, 2019, 108(1): 76-82.
[17] Troob SH, Self Q, Gerecci D, et al. Venous flow coupler in head and neck free flap reconstruction[J]. Otolaryngol Head Neck Surg, 2021, 164(3): 574-579.
[18] 李春洁,韩波,朱桂全.口腔颌面部缺损游离皮瓣修复中血管吻合的技巧及关键点[J].华西口腔医学杂志,2022,40(3): 271-278.
[19] 王深明,武日东.下肢深静脉血栓形成治疗指南与实践[J].中国实用外科杂志,2015,35(12): 1264-1266+1304.
[20] 中华医学会外科学分会血管外科学组.利伐沙班临床应用中国专家建议——深静脉血栓形成治疗分册[J].中国血管外科杂志(电子版),2013,5(4): 209-213.
[21] Hidalgo DA, Pusic AL. Free-flap mandibular reconstruction: a 10-year follow-up study[J]. Plast Reconstr Surg, 2002, 110(2): 438-449; discussion 450-451.
[22] Rana M, Warraich R, Kokemüller H, et al. Reconstruction of mandibular defects-clinical retrospective research over a 10-year period[J]. Head Neck Oncol, 2011, 3: 23.
[23] Ma H, Van Dessel J, Shujaat S, et al. Long-term functional outcomes of vascularized fibular and iliac flap for mandibular reconstruction: A systematic review and meta-analysis[J]. J Plast Reconstr Aesthet Surg, 2021, 74(2): 247-258.

编辑推荐 0

Metrics

阅读次数

全文

122

HTML			PDF

最新录用	在线预览	正式出版	最新录用	在线预览	正式出版
0	0	0	0	0	122

来源	本网站	其他网站

次数	39	83
比例	32%	68%

摘要

128

最新录用	在线预览	正式出版

0	0	128

	来源	本网站

	次数	129
	比例	100%

两种血管化游离骨移植修复下颌骨缺损的回顾性研究

Retrospective Comparative Study of Two Types of Vascularized Free Bone Transplantation for Repairing Mandibular Defects

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 6

编辑推荐 0

Metrics

[1]	刘纯, 王静文, 赵蕤, 赵欣欣, 赵熠. 节段性下颌骨切除腓骨重建后全口义齿修复1例[J]. 口腔医学研究, 2023, 39(4): 375-377.
[2]	李鹏, 邵小云, 李燕玲, 黄达鸿, 曾华江, 汤炜. 下颌骨重建个性化修复体暴露原因的有限元分析[J]. 口腔医学研究, 2018, 34(4): 424-427.
[3]	王育新,王志勇,卢明星,韩伟,卢晓林. 系列数字化导板在腓骨肌皮瓣修复下颌骨缺损中的初步应用[J]. 口腔医学研究, 2017, 33(5): 542-545.
[4]	张云绮 ,贾保军 ,敖建华 ,屈丹阳 ,雷鸣. 3D打印技术在下颌骨缺损修复中应用的初步临床研[J]. 口腔医学研究, 2016, 32(5): 517-520.
[5]	张庆福,刘刚,刘国勤. 个体化3D打印钛合金下颌骨植入体的设计制作与临床应用[J]. 口腔医学研究, 2015, 31(1): 48-51.
[6]	林文清,胡砚平,张文峰. 两种血管化游离骨肌瓣移植修复下颌骨缺损临床分析[J]. 口腔医学研究, 2015, 31(1): 81-84.