腓骨肌瓣结合牙种植牵引器在下颌骨功能性重建中的应用  

Functional reconstruction of mandible with fibulaflap and dental implant - distracter in one-stage

作　　者：张陈平[1] 张志愿[1] 季彤[1] 胡永杰[1] 韩正学[1] 徐立群[1] 吴轶群[1] 马继壮[1] 

机构地区：[1]上海第二医科大学附属第九人民医院口腔颌面外科,上海200011

出　　处：《中国耳鼻咽喉头颈外科》2004年第5期281-284,共4页Chinese Archives of Otolaryngology-Head and Neck Surgery

摘　　要：目的 探讨腓骨肌瓣结合牙种植牵引器(dentalimplant distracter,DID)在下颌骨功能性重建中的应用。方法 设计了包含永久性牙种植体和暂时性牵引器的牵引种植体。此牵引器特别为腓骨增宽牵引重建下颌骨缺损而设计。已完成10例下颌骨缺损重建(33件DID),其中4例成釉细胞瘤,2例下颌骨囊肿,1例骨纤维异常增殖症,其余3例为恶性肿瘤;患者年龄19～67岁(平均年龄44.7岁),8例男性,2例女性。结果在19～40个月的随访中,10例患者的组织瓣获完全成功,临床检查及X线检查显示正常下颌骨外形和骨愈合。植入的33枚DID中,有10枚(占30 %)由于局部感染松动取出,其余种植体均有良好的骨结合,成功率达70 %,共有4位患者完成义齿修复,效果满意。结论 DID可成功用于游离腓骨肌瓣下颌骨功能性重建,牙种植体植入与骨牵引同期完成,缩短了手术周期,改善了患者的生存质量。OBJECTIVE To study the applicationof Dental Implant Distracter (DID) with fibula in man-dibular functional reconstruction. METHODS We de-signed a new device named DID (Dental ImplantDistracter), which including the permanent dental im-plant and the temporary distracter in itself. It抯 spe-cially designed for fibula wider distraction in mandiblereconstruction. Thirty-three sets of DID devices wereused in 10 patients (8 males and 2 females) duringoperations. Four patients suffered from ameloblastomaof mandible, 2 from odontogenic cyst of mandible, 1from fibrous dysplasia, and the other 3 from malignanttumor of mandible. The age of 10 patients was from 19to 67 (average 44.7) years old, 8 males and 2 females.RESULTS The free flaps of all cases were survivedduring postoperative 19~40 months follow up.The clini-cal examination and X-ray film showed normal contourof mandible. Most cases showed good osteointegrationsurround DID, but 30 %(10/33) of the DID devices wereremoved because of the inflammation. The other 23(70 %) implants were solid enough to load the dentureforce. Four of the patients were successfully worn thefixed dental prosthesis. The outcomes were satisfied.CONCLUSION DID device, which specially designedfor mandibular functional reconstruction with fibula flap,could help us to simplify convenient procedures to asingle surgery.[

关 键 词：腓骨肌瓣 牙种植牵引器 下颌骨 功能性重建 

分 类 号：R782[医药卫生—口腔医学]