术中下颌骨临时外固定装置在下颌骨重建中临床应用研究  

Clinical application of intraoperative temporary mandibular external fixator in mandibular reconstruction

作　　者：祖丽胡玛·卡迪 阿迪力江·赛买提[1] 张思敏 木合森·牙生江 刘迪 尼加提·努尔穆罕默德 买买提吐逊·吐尔地[1] Zulihuma Kadi;Adilijiang Saimaiti;Zhang Simin;Muhesen Yashengjiang;Liu Di;Nijiati Nuermuhanmode;Maimaitituxun Tuerdi;Orthognathic and Trauma(Department of Oral&Maxillofacial Surgery,the First Affiliated Hospital(Stomatolgical Hospital)of Xinjiang Medical University,Urumqi 830054)

机构地区：[1]新疆医科大学第一附属医院(附属口腔医院)口腔颌面创伤正颌外科,新疆维吾尔自治区口腔医学研究所,乌鲁木齐830054

出　　处：《现代口腔医学杂志》2023年第4期261-267,共7页Journal of Modern Stomatology

摘　　要：目的探讨下颌骨临时外固定装置在下颌骨缺损重建术中的临床应用及效果。方法对收治的12例行下颌骨节段性切除术及血管化游离腓骨瓣修复并使用下颌骨临时外固定装置的患者临床数据进行回顾和分析,记录患者术前术后张口度及咬合关系,测量全景X线片中颞下颌关节前上后间隙,评估髁突在关节窝的位置及变化,记录患者外貌、咀嚼、发音满意度。结果术后随访6个月,与术前相比,术后即刻张口受限程度明显增高,3~6月张口度逐渐恢复正常。术后患者对面部外形、咀嚼及语音功能满意度高。术前术后健患侧髁突位置的测量结果显示,与术前相比,患侧术后即刻髁突前上移位,随访期间与术前相比发生上移位,差异有统计学意义(P<0.05),随访期间与术后即刻相比发生后移位,但差异无统计学意义(P>0.05)。结论下颌骨临时外固定装置应用于下颌骨缺损重建术中操作简单,可有效稳定髁突位置,辅助恢复下颌骨形态,效果理想;术后患者咬合关系及张口度恢复良好,面部形态、咀嚼、发音满意度高,可成为医患双向满意且经济快速的下颌骨重建术中的选择,值得临床推广应用。Objective To investigate the clinical application and effect of temporary mandibular external fixator in the reconstruction of mandibular defect.Methods The clinical data of 12 patients with mandibular resection and vascularized free fibula flap with temporary mandibular external fixator were reviewed and analyzed.Degree of mouth opening and occlusal relationship were recorded before and after surgery,the anterior superior and posterior space of temporomandibular joint was measured in panoramic X-ray film,and the position and changes of condyle in articular fossa were evaluated.Recorded the patients'satisfaction with appearance,mastication and pronunciation after operation.Results Postoperative follow-up for 6 months showed that the degree of limitation of mouth opening immediately after operation was significantly higher than that before operation,and gradually returned to normal in 3~6 months.Postoperative patients were highly satisfied with facial appearance,mastication and pronunciation.Measurement results of the condylar position of the healthy side and the affected side before and after operation showed that compared with before operation,the anterior upward displacement of the condylar process of the affected side occurred in immediately after operation,and the upward displacement occurred during the follow-up period,and the difference was statistically significant(P<0.05).The posterior displacement occurred during the follow-up period compared with the immediately after operation,but the difference was not statistically significant(P>0.05).Conclusion The temporary mandibular external fixation device is easy to operate,could effectively stabilize the condylar position and assist to restore the mandible contour,the occlusal relationship and mouth opening of the patients recover well after surgery.Facial contour,mastication and pronunciation are ideal,which can be used as a satisfactory and economical choice for intraoperative fixation in mandibular reconstruction,which is worth clinical application.

关 键 词：下颌骨节段性切除 即刻重建 临时外固定装置 髁突位置 

分 类 号：R782.4[医药卫生—口腔医学]