种植联合血管化髂骨移植重建14例下颌骨缺损的长期疗效观察  

Long-term performance of dental implants in vascularized iliac crest grafts for mandibular reconstruction in 14 consecutive patients

作　　者：顾雨薇 王凤[2] 黄伟[2] 张志勇[3] 张陈平[4] 孙坚[4] 吴轶群[1] GU Yu-wei;WANG Feng;HUANG Wei;ZHANG Zhi-yong;ZHANG Chen-ping;SUN Jian;WU Yi-qun(Department of Second Dental Center,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,College of Stomatology,Shanghai Jiao Tong University,National Center for Stomatology,National Clinical Research Center for Oral Diseases,Shanghai Key Laboratory of Stomatology,Shanghai 200011,China;Department of Oral Implantology,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,College of Stomatology,Shanghai Jiao Tong University,National Center for Stomatology,National Clinical Research Center for Oral Diseases,Shanghai Key Laboratory of Stomatology,Shanghai 200011,China;Department of Oral Special Consultation,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,College of Stomatology,Shanghai Jiao Tong University,National Center for Stomatology,National Clinical Research Center for Oral Diseases,Shanghai Key Laboratory of Stomatology,Shanghai 200011,China;Department of Oromaxllofacial Head and Neck Oncology,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,College of Stomatology,Shanghai Jiao Tong University,National Center for Stomatology,National Clinical Research Center for Oral Diseases,Shanghai Key Laboratory of Stomatology,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院口腔第二门诊,上海交通大学口腔医学院,国家口腔医学中心,国家口腔疾病临床医学研究中心,上海市口腔医学重点实验室,上海200011 [2]上海交通大学医学院附属第九人民医院口腔种植科,上海交通大学口腔医学院,国家口腔医学中心,国家口腔疾病临床医学研究中心,上海市口腔医学重点实验室,上海200011 [3]上海交通大学医学院附属第九人民医院口腔特需科,上海交通大学口腔医学院,国家口腔医学中心,国家口腔疾病临床医学研究中心,上海市口腔医学重点实验室,上海200011 [4]上海交通大学医学院附属第九人民医院口腔颌面-头颈肿瘤科,上海交通大学口腔医学院,国家口腔医学中心,国家口腔疾病临床医学研究中心,上海市口腔医学重点实验室,上海200011

出　　处：《中国口腔颌面外科杂志》2022年第5期488-493,共6页China Journal of Oral and Maxillofacial Surgery

基　　金：中国医学科学院医学与健康科技创新工程项目资助(2019-I2M-5-037);上海交通大学医学院附属第九人民医院口腔医学研究型学科基金(KQYJXK2020)。

摘　　要：目的:通过临床及影像学方法,评估种植联合血管化髂骨移植重建下颌骨缺损的长期疗效。方法:对上海交通大学医学院附属第九人民医院1995-2005年收治的14例患者47颗植入血管化髂骨的种植体进行随访,其中10例30颗种植体为下颌骨血管化髂骨重建术中同期植入,4例17颗种植体为术后二期植入,上部结构均采用种植支持式固定义齿修复。评估分析种植体15年累积生存率及修复体生存率,修复完成后5年及10年分别进行临床评价。采用SPSS 26.0软件包对数据进行统计学分析。结果:种植体均未发生愈合期内失败。种植体10年、15年累积生存率分别为90.44%和86.67%,修复体15年累积生存率为78.32%。种植体5年及10年边缘骨吸收分别为(2.08±0.27)mm和(4.22±0.48)mm,两者有显著差异(P<0.0001)。生物学并发症主要为种植体周围炎及软组织增生,机械并发症主要为修复体磨耗。结论:种植联合血管化髂骨移植重建下颌骨缺损的长期疗效较为稳定,是下颌骨缺损重建的有效方法;但种植体周围炎发生率较高,维护种植体周围软、硬组织的稳定是种植体远期疗效的重要保证。PURPOSE:To evaluate the long-term performance of dental implants installed in vascularized iliac crest grafts for mandibular reconstruction by clinical and radiographic examinations. METHODS:From 1995 to 2005, 47 implants installed in vascularized iliac crest grafts for mandibular reconstruction in 14 patients were analyzed, including 30implants immediately placed into vascularized iliac crest grafts in 10 patients and 17 implants placed later in 4 patients.The cumulative survival rate within 15 years of dental implants and prostheses was evaluated. Clinical assessments and ra-diographic examination were performed 5 years and 10 years after implant loading. Statistical analysis was performed using SPSS 26.0 software package. RESULTS:No early failures occurred during the healing period. Cumulative survival rates of implants for 10 years and 15 years were 90.44% and 86.67% and cumulative survival rate of prostheses for 15 years was 78.32%, respectively. The average marginal bone loss at 5 years was(2.08 ±0.27) mm, while that at 10 years was(4.22±0.48) mm(P<0.0001). Biological complications were peri-implantitis and soft tissue hyperplasia, and mechanical complication was abrasion of the prostheses mainly. CONCLUSIONS:The long-term performance of dental implants installed in vascularized iliac crest grafts for mandibular reconstruction is stable, which is an effective method for mandibular defect reconstruction, but the incidence of peri-implantitis is relatively higher. So, maintaining the stability of soft and hard tissues around the implant is a crucial guarantee for the long-term performance of implants.

关 键 词：血管化髂骨 种植体 下颌骨缺损 生存分析 

分 类 号：R783.4[医药卫生—口腔医学]