下颌骨缺损非血管化髂骨游离移植感染病例分析

Analyses of the infected cases of non-vascularization free iliac bone graft in reconstruction of mandibular defects

目的:总结分析下颌骨缺损非血管化髂骨游离移植感染发生的原因,进一步明确非血管化髂骨游离移植修复和重建下颌骨的适应证、禁忌证。方法:回顾性分析10例下颌骨缺损非血管化髂骨游离移植病例,对比分析感染与非感染病例下颌骨缺损范围、受植区软组织情况、移植骨离体至内固定完成的时间、患者全身状况等。结果:非感染病例全部满足受植区软组织血运好、全身状况好的条件。3例感染病例中,2例的感染原因主要为受植区软组织血运差(分别为受植区软组织薄弱、软组织瘢痕形成)引起,1例为授乳期患者,术后并发肺不张,全身抵抗力差所致,另外,该例骨缺损范围大、移植骨分段塑形复杂、离体时间长等也与感染的发生有关。结论:下颌骨缺损非血管化髂骨游离移植感染的发生与多种因素有关。最重要的是受植区软组织的条件及患者的全身情况。临床应用中应严格掌握该技术的适应证和禁忌证,防止移植骨感染,提高移植效果。

Objective:To summarize and analyze the infection reasons of non-vascularization free iliac bone graft in reconstruction of mandibular defects and make a clear understanding of the indications and contraindications of non-vascularization free iliac bone graft in reconstruction of mandibular defects.Methods:Retrospective analysed 10 cases of non-vascularization free iliac bone graft in mandibular defect,comparatively analyzed the rang of mandibular defect,soft tissue condition of receptive region,exsomative period of graft bone and patient′s general condition between infection and non-infection cases.Results:There were 3 infected cases.The infections were caused by the poor blood supply of the soft tissue of receptive region in 2 cases.The infection was caused by postoperative atelectasis and poor resistance in 1 case of a lactation patient.Besides that,the infection was maybe relative to wide range of mandibular defect,complicated segmental moulding and long exsomative period of graft bone.Conclusion:Infections of non-vascularization flee iliac bong graft in reconstruction of mandibular defect is caused by many factors.But the most importantfactors are the soft tissue condition of receptive region and patient′general condition.During clinical application,we should strictly master its indications and contraindications,to prevent the infections of graft bone and improve the graft effect.