带肋骨胸大肌肌皮瓣与腓骨(皮)瓣修复重建下颌骨疗效对比分析

Comparative study of the clinical effect of mandible reconstruction with pectoralis major muscle musculo-cutaneous flap plus rib and fibular free flap

目的通过对带肋骨胸大肌肌皮瓣与腓骨(皮)瓣修复重建下颌骨形态及功能的临床疗效进行随访对比分析,提供修复重建下颌骨的临床治疗方法和选择依据。方法19例下颌骨缺损分为两组。组Ⅰ:带肋骨胸大肌肌皮瓣修复重建下颌骨8例,其中创伤6例,肿瘤2例;组Ⅱ:腓骨(皮)瓣修复重建下颌骨11例,其中创伤7例,肿瘤4例。术后6,12,24,36个月随访观察、对比分析、评价下颌骨形态及功能恢复情况。结果接受带肋骨胸大肌肌皮瓣与腓骨(皮)瓣方法修复重建下颌骨的19例患者术后随访观察、对比分析、评价结果显示,对下颌骨形态恢复比较,两种方法差异无统计学意义,对下颌骨功能恢复比较,两种方法差异有统计学意义。结论带肋骨胸大肌肌皮瓣与腓骨(皮)瓣修复重建下颌骨形态方面有一致的临床疗效;腓骨(皮)瓣对下颌骨功能重建的临床疗效优于带肋骨胸大肌肌皮瓣。

Objective To compare the clinical effect of pectoralis major muscle musculo-cutaneous flap plus rib and fibular free flap in mandible reconstruction so as to cater the selective basis for clinical of mandible reconstruction. Methods A total of 19 cases of mandibular lesions were divided into two groups, ie, mandible reconstruction with pectoralis major muscle musculo-cutaneous flap plus rib (Group I, 8 cases, of which 6 with trauma and 2 with carcinoma.) and with fibular free flap (Group II, 11 cases, of with 7 with trauma and 4 with carcinoma.). Functional and aesthetic restoration were analyzed and evaluated 6, 12, 24 and 36 months respectively after treatment. Results There was no significant difference upon mandibular aesthetic restoration posterior to treatment with pectoralis major muscle musculo-cutaneous flap plus rib or fibular free flap but significant difference upon mandibular functional recovery. Conclusions The clinical results of pectoralis major muscle musculo-cutaneous flap plus rib and fibular free flap have consistency in clinical effect, but the latter one is better than the former one in mandibular reconstruction.