游离腓骨瓣移植修复151例下颌骨放射性骨坏死缺损的效果评价  

Evaluation of the effect of free fibular flap transplantation in repairing mandibular osteoradionecrosis defect in 151 cases

作　　者：李群星[1] 曹昊天 李妍彦 欧展鹏 林欣祤 张汉卿[1] 林钊宇[1] 王友元[1] 谢舒乐 潘朝斌[1] 张彬[1] 王建广[1] 陈伟良[1] 黄志权[1] 范松[1] 李劲松[1] Li Qunxing;Cao Haotian;Li Yanyan;Ou Zhanpeng;Lin Xinyu;Zhang Hanqing;Lin Zhaoyu;Wang Youyuan;Xie Shule;Pan Chaobin;Zhang Bin;Wang Jianguang;Chen Weiliang;Huang Zhiquan;Fan Song;Li Jinsong(Department of Oral and Maxillofacial Surgery,Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University,Guangzhou 510120,China)

机构地区：[1]中山大学孙逸仙纪念医院口腔颌面外科,广州510120

出　　处：《中华口腔医学杂志》2021年第5期428-434,共7页Chinese Journal of Stomatology

基　　金：广东省科技计划项目(2015B010125002)。

摘　　要：目的探讨游离腓骨瓣修复下颌骨放射性骨坏死(osteoradionecrosis,ORN)缺损的临床疗效。方法选取2005年8月至2020年9月中山大学孙逸仙纪念医院口腔颌面外科收治的151例下颌骨ORN行游离腓骨瓣修复患者,其中男性109例,女性42例,年龄(54.1±10.1)岁(31~85岁)。收集患者的临床资料,统计皮瓣存活率及术后功能等评价手术疗效。正态分布数据用"xˉ±s"表示,非正态分布数据用"M(QR)"表示,采用χ2检验进行差异分析。结果 151例患者中,因鼻咽癌放疗造成的下颌骨ORN占79.5%(120/151);出现下颌骨ORN平均时间为放疗后5(6)年。受区吻合动脉以面动脉[57.2%(87/152)]和甲状腺上动脉[32.9%(50/152)]为主,二者皮瓣的坏死率[分别为10.3%(9/87)和10.0%(5/50)]差异无统计学意义(P=0.949)。受区吻合静脉以颈外静脉[48.4%(135/279)]和面总静脉[26.5%(74/279)]为主;其中25例(16.6%)吻合1条静脉,126例(83.4%)吻合2条静脉,二者的皮瓣坏死率[分别为20.0%(5/25)和7.1%(9/126)]差异无统计学意义(P=0.100)。97例(64.2%)患者以腓骨肌皮-筋膜复合瓣修复颌面软硬组织缺损;13例(8.6%)行数字化虚拟手术设计修复,其中5例同期种植牙修复。术后17例(11.3%)患者发生下呼吸道感染;3例(2.0%)出现上呼吸道梗阻。术后皮瓣成活率为90.1%(136/151),21例(13.9%)出现皮瓣血管危象,33例(21.9%)出现颌面部创口延期愈合。随访3~24个月,110例(76.9%)患者口腔内外无瘘口,118例(82.5%)患者术后开口度改善≥0.5 cm,135例(94.4%)患者疼痛得到缓解,97例(67.8%)患者可正常饮食或进食半流质、软食,137例(95.8%)患者对治疗效果满意或基本满意。结论游离腓骨瓣是修复下颌骨ORN缺损的有效手段,术前血管评估有助于受区血管的选择,面动脉和甲状腺上动脉、颈外静脉和面总静脉可作为主要受区血管。腓骨肌皮-筋膜复合瓣修复利于口内外瘘口关闭,数字化技术可更精确恢复颌面部外形,并改善患者�Objective To investigate the clinical effect of free fibula flap transplantation in repairing the defect of mandibular osteoradionecrosis(ORN).Methods A total of 151 mandibular ORN patients undergoing free fibular flap transplantation were selected from August 2005 to September 2020 in the Department of Oral and Maxillofacial Surgery,Sun Yat-sen Memorial Hospital,Sun Yat-sen University.Among them,109 patients were males and 42 patients were females,aged(54.1±10.1)(ranged 31-85)years old.The clinical data of the patients was collected and the survival rate of the flaps and postoperative function were calculated to evaluate the surgical efficacy.Theχ^(2) test was used for difference analysis.Results Among the 151 patients,mandibular ORN caused by radiotherapy for nasopharyngeal carcinoma accounted for 79.5%(120/151).The average time for mandibular ORN appeared was 5(6)years after radiotherapy.Facial artery[57.2%(87/152)]and superior thyroid artery[32.9%(50/152)]were the main anastomotic arteries in the recipient area.There was no significant difference in the necrosis rates of the two flaps[10.3%(9/87)and 12.5%(5/50),respectively,P=0.949].The main anastomotic veins in the recipient area were the external jugular vein[48.4%(135/279)]and the common facial vein[26.5%(74/279)].Twenty-five cases(16.6%)had one vein anastomosed,and 126 cases(83.44%)had two veins anastomosed.There was no significant difference in the flap necrosis rate between the two conditions[20.0%(5/25)and 7.1%(9/126),respectively,P=0.100].Ninety-seven cases(64.2%)used the peroneal musculocutaneous-fascia composite flap to repair the maxillofacial soft and hard tissue defects.Thirteen cases(8.6%)underwent the restorations with digital virtual surgery design,of which 5 cases were repaired with dental implants at the same time.After the operations,lower respiratory tract infection occurred in 17 patients(11.3%),and upper respiratory tract obstruction occurred in 3 cases(2.0%).The survival rate of the flap after operation was 90.7%(136/151),and 21 patie

关 键 词：骨坏死 放射性 下颌骨放射性骨坏死 受区血管 腓骨肌皮-筋膜复合瓣 数字化技术 

分 类 号：R782.4[医药卫生—口腔医学]