单侧上颌骨缺损重建与赝复体修复临床评价

Clinical Evaluation of Literal Maxillectomized Patients with Surgical Rehabilitation or Prosthodontic Rehabilitation

目的评价上颌骨切除术后重建和赝复体修复的临床效果。方法根据上颌骨切除术后修复的方式分成2组;①手术重建组10例,即在手术切除上颌骨同期运用前臂游离皮瓣或串联腓骨瓣行上颌骨缺损重建修复;②赝复体修复组10例,上颌骨切除术后未行手术重建,术后配戴修复体。结果测量20例患者戴修复体3个月后的咀嚼效率在73%-94%之间,平均为81%±7.2%,赝复体修复组的咀嚼效率:47%-82%之间,平均为(67.1±9.8)%。经配对t检验表明二者间有显著性差异(P<0.05);手术重建组戴修复体3个月后语音清晰度为92%-98%之间,平均为(96±2.8)%;赝复体修复组63%-98%之间,平均为(83±7.1)%,二者相比差异有显著性(P<0.05)。结论上颌骨大型缺损手术重建较传统赝复体修复能更好地保持患者口鼻腔的封闭,腭部。牙槽嵴形态恢复以及软腭功能保存较好,在咀嚼功能和语音功能恢复方面具有明显的优势。

Objective To evaluate the clinical effectiveness of the literal maxillectomized patients with surgical rehabilition or prosthodontic rehabilition. Methods According to the rehabilitative methods maxillary defects, patients were divided into two groups. One was the surgical rehabilitation group （10 cases） ,in which the maxillary defects were reconstructed with forearm free flap or combined with fibular flap. The other was the prothodontic rehabilitation group （ 10 cases） in which the defects were covered with the traditional prothesis. The masticatory efficiency and speech intelligibility of 20 patients with maxillary defects were measured postoperatively 3 months after prosthesis. Results The masticatory efficiency in surgical rehabilitation group was 73% -94% （mean 81% ±7. 2% ） ;The masticatory efficiency in prothodontic rehabilitation group was 47% -82% （mean 67. 1%± 9. 8% ）. There was significant difference between two groups by using Student t test（ P 〈0. 05 ）. Speech intelligibility in surgical rehabilitation group was 92% - 98% （ mean 96% ± 2. 8% ） ; Speech intelligibility in prothodontic re- habilitation group was 63% - 98% （ mean 83% ±7. 1% ）, There was significant difference between two groups（ P 〈 0. 05 ）. Conclusion Surgical rehabilitation can better restore masticatory efficiency and speech intelligibility than prothodontic rehabilitation for the maxillectomized patients.