四种下颌骨缺损修复方法临床疗效评价

Clinical evaluation on four kinds of reconstruction of mandibular defect

目的:对分别采用自体骨煮沸回植、异体冻存骨移植、成品钛支架植入及个体定制化钛下颌植入等四种不同方法修复下颌骨缺损病例的外形、功能恢复情况,以及术后并发症情况进行综合评价。为临床合理选择下颌骨修复手段进行探索。方法:收集我院自1997年至2005年期间分别采用自体骨煮沸回植(A组)、异体冻存骨移植(B组)、成品钛支架植入(C组)、个体定制化钛下颌植入(D组)四种不同方法修复下颌骨缺损病例122例,比较外形、功能恢复效果;术后感染、植入体断裂等并发症的发生情况。结果:A组与D组外形和功能修复效果优于C组和B组(P<0.05)。C组和B组之间以及A组和D组之间均无显著性差异(P>0.05)。外形评价达到良好以上者,A组和D组优于B组和C组(P<0.05)。B组和C组之间无显著性差异(P>0.05)。感染率:A组7.5%,B组14.3%,C组11.9%,D组0,各组间无显著性差异(P>0.05)。植入体断裂率:A组5%,B组42.9%,C组19.0%,D组0,各组间无显著性差异(P>0.05)。结论:采用自体骨煮沸回植和定制化钛下颌修复下颌骨缺损的美观、功能效果明显优于采取异体冻存骨移植和成品钛支架的病例。四种方法在术后感染、植入物断裂等并发症的发病率方面无显著性差异。四种修复方法各有优缺点。决定临床下颌骨缺损功能重建疗效的关键,取决于临床适应证的掌握和手术中细节方面的处理。

Objective：To compare autoallergic boiled bone returnvariant,allogenic freeze bone transplantation,prepared titanium frame and individual titanium mandibular, four kinds of restorative procedure for reconstruct mandibular defect in outline form,functional restoration and postoperative complications. Mathods： To collect collect 122 cases applied four kinds of restorative procedures in our hospital from 1997 to 2005. Male 63 cases, female 59 cases, age 16-78, average 42.7 to compare outline form and functional recovery. Results： Featural and functional evaluation band good： autoallergic boiled bone returnvariant （group A） 90.4%, allogenic freeze bone transplantation （group B） 7.1%, prepared titanium frame （group C）18.2%, individual titanium mandibular （group D）100% ,group A and group D were better than group B and group C（P〈0.05）. Featural evaluation band good： group A and group D were better than group B and group C（P〈0.05）.Infection rate： group A 7.5%, group B 14.3%, group C 11.9%, group D 0, no significant difference （P〉0.05）. Fragmentation rate ： group A 5%, group B 42.9%, group C 19.0%, group D0 , no significant difference（P〉0.05）.Conclusion：The ways of autoallergic boiled bone returnvariant and individual titanium mandibular are batter than allogenic freeze bone transplantation and prepared titanium frame; The four kinds of restorative procedures of mandibular defect are no significant difference on complications.