钛重建板联合胸大肌肌皮瓣同期修复下颌骨放射性骨坏死切除术后缺损

Immediate reconstruction of the mandibular detect in patients with osteoradionecrosis using reconstructive Tiplate and pedicled pectoralis major myocutaneous flap

目的:探讨一种因大剂量放疗引起下颌骨放射性骨坏死的修复治疗手段。方法:2003年7月-2008年7月,对12例大剂量放疗引起的颈部受区血管破坏,无法进行显微外科修复的下颌骨放射性骨坏死患者,采用截骨并应用重建钛板联合胸大肌皮瓣进行修复,评价手术成功率和术后修复效果。结果:12例患者皮瓣全部存活,钛重建板无排异和外露,术后下颌骨全景片显示钛板固位良好,残余下颌骨无明显异常反应;1例患者术后2.5a出现钛板断裂。12例患者中,7例开口度达2.5cm以上,5例达2.0cm以上;对术后外形满意者6例,基本满意4例,稍不满意2例;术后残余牙咬合关系的偏差在0.5～1个牙位之间。结论:对于经受大剂量放疗导致的下颌骨放射性骨坏死患者,尤其是放疗时颈部受区血管破坏,无法进行显微外科重建的患者,钛重建板联合胸大肌皮瓣修复是一种有效、安全、相对简单的方法。

PURPOSE： To evaluate a reconstructive method in repairing the defect after resection of the osteoradionecrosis of the mandible. METHODS： 12 cases of the osteoradionecrosis of mandible from July 2003 to July 2008, underwent partial mandibulectomy. The reconstructive Ti-plate with pectoralis major myocutaneous flap was used to reconstruct the mandibular defects with or without adjacent soft tissue defects. The post-operative effects and flap successful rate were evaluated with a follow-up period of 3 months to 5 years. RESULTS： All the 12 flaps were 100% survival, and no plate exposure was found after operation in the follow up period. One plate fracture was found 2 and half years after r econstruction. The mouth opening was 2.0-2.5 cm and the occlusive deviation was limited to half to one tooth. 6 patients were satisfactory with the outlook, 4 patients felt fair with the outlook, and 2 patients had a little disappointment with the outlook. CONCLUSION： The reconstructive Ti-plate with pectoralis major myocutaneous flap is a cost-effective, safe method in reconstruction of the mandibular defects from osteonecrosis with or without adjacent soft tissue defects, especially in case of low quality of head and neck vascular donor sites for microsurgical reconstruction.