58例腓骨瓣修复下颌骨缺损后行种植义齿修复的疗效观察  

Clinical outcomes of implant denture application following mandibular defect repair with fibula flaps in 58 cases

作　　者：高宁[1] 付坤[1] 蔡菁华[1] 何巍[1] Gao Ning;Fu Kun;Cai Jinghua;He Wei(Department of Oral and Maxillofacial Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院口腔颌面外科,450052

出　　处：《中华整形外科杂志》2021年第6期624-631,共8页Chinese Journal of Plastic Surgery

摘　　要：目的探讨腓骨瓣修复下颌骨缺损后行种植义齿修复的治疗效果。方法以2015年3月至2018年1月郑州大学第一附属医院口腔颌面外科采用腓骨瓣修复下颌骨成釉细胞瘤切除术后缺损并行种植义齿修复的患者为研究对象。患者切除病变组织后使用游离腓骨瓣同期修复下颌骨缺损,骨移植后6~9个月植入Straumann软组织水平种植体,种植后3~4个月进行上部烤瓷冠修复,以恢复咬合关系和咀嚼功能。术后6、12个月进行复诊随访,观察手术修复效果,并应用欧洲癌症研究与治疗组织生命质量问卷的头颈专用问卷(EORTC QLQ-H&N35)和口腔健康影响程度量表(OHIP-14)对患者术前、术后6个月、术后12个月的生命质量进行调查和评估。采用方差分析进行3个时间点各量表(问卷)评分的比较,然后以SNK-q检验进行评分的两两比较。结果共纳入58例患者,男36例,女22例;年龄18~62岁,平均31.6岁。58例患者游离腓骨瓣全部成活,患者下颌骨缺损区的弧度得以恢复,颌面部对称,咬合关系良好,语言、咀嚼、吞咽功能恢复正常。EORTC QLQ-H&N35问卷调查显示:在饮食、社会接触和牙齿方面,术后6个月时评分最高,与术前相比差异有统计学意义(P<0.05),术后12个月时评分下降,与术前相比差异无统计学意义(P>0.05);在张口度方面,与术前相比,术后6个月和术后12个月时评分逐渐降低,且差异均具有统计学意义(P<0.05);在语言方面,术后6个月较术前评分升高,术后12个月时评分降至术前水平;在吞咽方面,各时间点的评分无明显改变(P>0.05)。OHIP-14量表调查显示:在功能限制、生理障碍和残障方面,术后6个月时评分升高,与术前相比差异有统计学意义(P<0.05),术后12个月时评分下降,与术前相比差异无统计学意义(P>0.05);在心理不适、心理障碍和社交障碍方面,术后6个月时评分升高,与术前相比差异有统计学意义(P<0.05),术后12个月时分值明Objective To explore the therapeutic effect of implant denture after repairing mandibular defect with fibula flaps.Methods The patients who received implant dentures following mandibular defect repair with fibula flaps to treat mandibular ameloblastoma were included as study subjects.These patients were admitted to the First Affiliated Hospital of Zhengzhou University from March 2015 to January 2018.The free fibular flap was used to repair the mandibular defect after the diseased tissue was removed.The Straumann soft tissue level implants were placed 6-9 months after bone grafting,and the upper porcelain crown was repaired 3 to 4 months after implantation to restore the occlusal relationship and chewing function.The patients were followed up 6 and 12 months after surgery to observe the effect of surgical repair.European Organization for Research and Treatment of Cancer quality of life questionnaire head and neck module(EORTC QLQ-H&N35)and the 14-item Oral Health Impact Profile(OHIP-14)questionnaires were applied to investigate and evaluate the quality of life of the patients before surgery and 6 months and 12 months after surgery.Results There were a total of 58 patients,36 males and 22 females,from 18 to 62 years old,with an average of 31.6 years old.In all of the 58 cases,the free flaps survived with restored curvature of the patient’s mandibular defect,symmetrical maxillofacial region and occlusal relationship.Their functions of speech,chewing,and swallowing have all returned to normal.The EORTC QLQ-H&N35 questionnaire survey showed that the score in terms of diet,social contact and teeth was the highest at 6 months after surgery,with statistically significant difference from the preoperative level(P<0.05);and the score decreased at 12 months after surgery,without statistically significant difference from the preoperative level(P<0.05).Compared to the preoperative level,the scores in terms of mouth opening both gradually decreased at 6 months and 12 months after surgery,without statistically significant diff

关 键 词：下颌骨截骨术 成釉细胞瘤 腓骨 牙种植 生活质量 

分 类 号：R782.2[医药卫生—口腔医学] R783.6[医药卫生—临床医学]