颧种植体在上颌骨缺损重建中的应用探讨  

Zygomatic implants anchorage for the rehabilitation of maxillary defects

作　　者：吴轶群[1] 张志愿[2] 张志勇[1] 孙坚[2] 黄伟[1] 胡永杰[2] 张陈平[2] 

机构地区：[1]上海第二医科大学附属第九人民医院.口腔医学院口腔种植中心,上海200011 [2]上海第二医科大学附属第九人民医院.口腔医学院口腔颌面外科,上海200011

出　　处：《上海口腔医学》2005年第3期210-214,共5页Shanghai Journal of Stomatology

基　　金："十五"国家科技攻关课题(2004BA720A27);上海市口腔研究所基金(02-07)

摘　　要：目的:评价颧种植体结合血管化骨瓣修复上颌骨缺损的效果。方法:对4例上颌骨切除术后缺损患者,利用三维CT数据,借助CAD/CAM系统制作1∶1大小的解剖模型,术前测量相关参数并制作精确种植模板。术中采用血管化骨肌皮瓣和骨结合牙种植体修复上颌骨缺损,利用上颌骨和颧骨的测量数据,结合定位模板共植入6枚颧种植体和7枚牙种植体,颧种植体结合血管化骨瓣重建上颌骨的形态和功能。结果:利用血管化骨瓣重建4例患者的上颌牙弓形态,使面中1/3得以恢复;在术前设计和术中植入6枚颧种植体和7枚常规种植体时,应用解剖学模型和外科模板,使种植体精确定位。结论:上颌骨术后缺损,可采用颧种植体重建颧上颌支柱,恢复面中1/3的形态;使用血管化骨瓣结合颧种植体,提高了上颌骨缺损修复的效果;颧上颌支柱的恢复,使牙合的稳定得到了保证,从而有利于美观和功能的恢复。PURPOSE:Prosthetic reconstruction of the upper jaw in patients with extensive bone and soft tissue defects is still a significant challenge. This study evaluated the functional results of zygomatic implants and vascularized bone graft reconstruction of the maxillary defects in 4 patients. METHODS: Complex resections of the maxilla produced a three-dimensional defect in 4 patients. On the basis of an axial spiral CT data, anatomical models of natural size by CAD/CAM system was manufactured to enable preoperative measurements of relevant parameters. After tumor resection, reconstruction using the fibula or iliac osteocutaneous flap with titanium osseointegrated implants was performed. Maxillary and zygomatic measurements were also used to obtain information for installing 6 zygomatic implants and 7 dental implants. RESULTS: The bone from the fibula or iliac osteocutaneous flap was contoured to recreate the maxillary arch in 4 patients. The anatomical model and surgical palate was used for preoperative planning and intraoperative control of the insertion of 6 zygomatic fixtures after subtotal maxillectomy. The implants could be positioned precisely as preoperatively planned. CONCLUSIONS: The use of zygomatic fixtures after ablative tumor surgery with resection of the maxillary bone is valuable in providing new zygomatic buttresses that play a key role in the form of the midface. Maxillary rehabilitation can be further improved by using the vascularized bone graft and zygomatic implants. Reconstitutions of the buttresses system ensure a stable base for occlusion, which is essential to optimal functional and esthetic maxillary rehabilitation. Supported by Research Fund (No. 2004BA720A27) of National Tenth Five-Year Project.

关 键 词：颧种植体 血管化骨瓣 上颌骨缺损 

分 类 号：R782[医药卫生—口腔医学]