钛网成形复合自体松质骨移植修复大型下颌骨缺损

Clinical application of titanium mesh shaped with autogenous iliac marrow-cancellous bone grafting to reconstructing severe mandible defects

目的应用和观察钛网成形复合自体髂骨松质骨移植即刻修复大型下颌骨缺损的临床疗效。方法取全口模型，结合Cr或X线片显示的病变大小和正常侧下颌骨的大小形态，用钛网预制再造的下颌骨支架；彻底切除下颌骨病灶；同期取自体髂骨骨松质，剪成颗粒状，紧密充填于预制的钛网内，调整咬合关系正常后，固定钛网。结果共治疗15例大型下颌骨缺损的患者，术后观察0．5～8年。除1例患者因术后感染二次手术取出部分钛网，创口二期愈合外，所有患者未见肿瘤复发和骨吸收，颜面对称，固定良好，瘢痕不明显，咬合关系正常，张口度3．5cm以上，张口不偏斜，其中8例已做义齿修复，患者对面形和功能恢复均感满意。结论应用钛网成形复合自体髂骨松质骨移植即刻修复大型下颌骨缺损，方法简单，成功率高，是一种修复大型下颌骨缺损的理想方法。

Objective To use and observe titanium mesh shaped with autogenous iliac marrow cancellous bone grafting for instantly reconstructing the severe mandible defects. Methods A full-mouth model was made according to the dimension of bone lesion on X-ray or CT and the shape of normal side of the mandible, and the reconstructive mandible was made with titanium mesh shaped. We thoroughly resected the lesion of mandible, and simultaneously harvested autogenous iliac marrow cancellous bone with partial cortical bone, and made the bone become grain. We restored the normal occluding rehfionship, and compactly filled the fabricated titanium mesh mandible with the iliac marrow cancellous bone, then fixed it by internal rigid fixation. Results Fifteen patients were treated with this method. Except that one wound was infected and healed in stage two, all wounds healed in stage one. All patients were followed up for 0.5 - 8.0 years without tumor recurrence and bone absorption, and the fixation of the titanium mesh mandible is good. All patients had symmetrical faces, unclear scar, and open mouth greater than 3.5 cm and normal occluding relationship. Eight cases have got denture restoration. All patients were satisfied with facial contour and functions. Conclusion The titanium mesh shaped with autogenous iliac marrow cancellous bone grafting for instantly reconstructing the severe mandible defect is simple, convenient, and of high success rate. This method is an ideal way of reconstructing severe mandible detects.