游离骨移植重建下颌骨的面部美容改进措施  

Aesthetic improvements in free-bone graft mandible reconstruction

作　　者：翦新春[1] 邹智[1] 左军[1] 许春姣[1] 尹乒[1] 

机构地区：[1]中南大学湘雅医院口腔颌面外科,长沙410008

出　　处：《中华医学美学美容杂志》2004年第2期74-78,共5页Chinese Journal of Medical Aesthetics and Cosmetology

摘　　要：目的　探讨下颌骨缺损重建中骨移植体塑形在下颌骨重建美学中的地位。方法　选 30例下颌骨缺损重建患者作为研究对象 ,移植体取自体髂骨、肋骨、锁骨或腓骨。下颌骨移植体的塑形从下颌角的形成开始 ,当下颌升支和髁状突骨段已用微型夹板固定之后 ,应将注意力集中于将成为下颌骨体的移植体上。如下颌骨截骨未达下颌骨正中线 ,在行移植体的塑形时可仅做 1次截骨就即可了 ;如达下颌骨中线者 ,在行下颌移植体塑形时就必须在中线附近行第 2次截骨以增加移植体的弯曲度。在对移植体塑形并用微型夹板固定之后 ,将骨移植体与剩余下颌骨断端也用微型夹板固定。术后曲面体层摄影追踪观察。结果　 30例中 ,监控观察 5年以上者 13例 ,1年以上者 17例 ;其中 1例术后 2年 3个月后微型钛板折断 ,经手术改用小钢板固定后骨愈合 ,2 9例移植体全部愈合。面部外形满意 ,剩余牙咬合关系良好。结论　移植骨塑形的质量对面部美学有重要的影响。Objective To describe a method that can produce the best aesthetic results in mandible reconstruction. Methods Thirty patients were selected for research objects of reconstruction of the mandibular defect. The donor sites of 30 patients for free-bone graft mandilble reconstruction included the ilium, the rib, the clavicle and the fibula. The shaping of lateral graft began by forming the angle of the mandible. After the ramus and condyle segment had been fixed with miniplates, attention was turned to shaping the adjacent portion of the graft, which would become the body of the mandible. The process began by determining what the length of the graft an osteotomy was needed to reproduce the curve in the body. Only one osteotomy was usually necessary in the case of a typical lateral resection that did not extend as far as the midline. This osteotomy was made in two planes because the native mandible not only had a change in the degree of its curve, but also usually angles either upward or downward at this transition point. Lateral grafts that extended to the midline usually required a second osteotomy to increase the curve near the midline. It was always the best to leave the graft long after the first osteotomy and performed the second osteotomy at the time of graft insetting. After placement of miniplates, graft shaping was complete, and graft was fixed to the resected end of the remaining mandible with the two miniplates. Bone healing was monitored in all patients with serial Panorex studies. Results Thirteen patients of 30 had been monitored for over 5 years, and seventeen patients monitored for over 1 year; One of 30 patients was related to fracture of miniplate, and healed later with plate replacement. The facial contour and occlusal relation of 29 patients were satisfactory. Conclusion The quality of shaping the bone graft may affect facial aesthetics. [

关 键 词：游离骨移植 下颌骨重建 面部美容 下颌骨缺损 

分 类 号：R782.2[医药卫生—口腔医学]