两种血管化游离骨移植修复下颌骨缺损的回顾性研究  

Retrospective Comparative Study of Two Types of Vascularized Free Bone Transplantation for Repairing Mandibular Defects.

作　　者：周旺 吕伟华 王希乾 仝春实 武洋 彭利伟[2] ZHOU Wang;LV Weihua;WANG Xiqian;TONG Chunshi;WU Yang;PENG Liwei(Henan University School of Stomatology,Zhengzhou 450000,China;Department of Oral and Maxillofacial Surgery,Henan Provincial People's Hospital,Zhengzhou 450000,China.)

机构地区：[1]河南大学口腔医学院,河南郑州450000 [2]河南省人民医院口腔颌面外科,河南郑州450000

出　　处：《口腔医学研究》2024年第12期1059-1064,共6页Journal of Oral Science Research

摘　　要：目的:总结分析我院口腔颌面外科近几年收治的因各种原因导致下颌骨缺损的病例,比较血管化游离腓骨瓣和髂骨瓣的优缺点及临床效果。方法:回顾性分析比较血管化游离腓骨瓣及髂骨瓣修复下颌骨缺损的适应证、围手术期信息和预后情况。结果:27例腓骨瓣及32例髂骨瓣均成活,两者在一般资料、面部外形和功能恢复(术后6个月后)方面比较无明显差异,在下颌骨缺损类型和长度、手术时间、ICU住院时间、术后住院时间上比较明显不同。结论:下颌角处缺损优先考虑血管化游离髂骨瓣修复,跨越中线的缺损优先考虑血管化游离腓骨瓣修复,Brown分类方法能够很好指导骨瓣选择的类型。缺损大于90 mm优先考虑腓骨修复,且可以同时携带皮岛修复软组织缺损,小于90 mm不伴有软组织缺损优先考虑髂骨修复,小于90 mm伴有软组织缺损携带阔筋膜张肌瓣修复。血管化游离髂骨瓣在手术时间、ICU住院时间及术后住院时间明显优于血管化游离腓骨瓣。血管化游离腓骨瓣和髂骨瓣均能很好地恢复患者面部外形和口腔功能,且无明显差异。Objective:To summarize and analyze the cases of mandibular defects caused by various reasons in the maxillofacial surgery team of our hospital in recent years,and compare the advantages,disadvantages,and clinical effects between vascularized free fibular flap and iliac flap.Methods:A retrospective study was conducted on 59 cases of vascularized free fibular and iliac flaps for repairing mandibular defects.The indications,perioperative information,and prognosis of vascularized free fibular and iliac flaps for repairing mandibular defects were evaluated and compared.Results:Twenty-seven cases of fibular flap and 32 cases of iliac flap survived,and there was no significant difference in general information,facial appearance,and oral function recovery(6 months after surgery)between two groups.There were significant differences in the type and length of mandibular defect,surgical time,ICU hospitalization time,and postoperative hospitalization time.Conclusion:For mandibular angle defects,vascularized free iliac flap repair is prioritized,while for defects crossing the midline,vascularized free fibular flap repair is prioritized.The Brown classification method can effectively guide the selection of bone flap types.For defects larger than 90 mm,priority should be given to fibular repair,and skin islands can be carried simultaneously to repair soft tissue defects.For defects smaller than 90 mm without soft tissue defects,priority should be given to iliac bone repair.For defects smaller than 90 mm with soft tissue defects,tensor fascia lata flap should be carried for repair.The vascularized free iliac flap is significantly better than the vascularized free fibular flap in terms of surgical time,ICU hospital stay,and postoperative hospital stay.Both vascularized free fibular and iliac flaps can effectively restore the patient's facial appearance and oral function without significant differences.

关 键 词：血管化游离腓骨瓣 血管化游离髂骨瓣 下颌骨缺损 修复重建外科 功能及外形评价 

分 类 号：R782.4[医药卫生—口腔医学]