下颌骨缺损修复重建方法选择的临床研究

Clinical Study of Methods Selection of Mandibular Reconstruction

目的分析三种常用下颌骨缺损修复重建方法在临床应用中的选择与修复重建的时机选择。方法收集1994年12月～2007年12月期间在我院因各类肿瘤切除手术后实施下颌骨缺损修复重建的患者142例,分析与下颌骨修复方法选择相关的各种因素,包括病变性质、患者家庭经济状况、是否有软组织缺损、是否进行了放/化疗。将下颌骨缺损进行HCL方法分类,并比较各类缺损修复方法与修复时机的选择。结果本组142例患者中采用自体游离骨移植103例(72.6%),采用游离血管化骨肌瓣移植8例(5.6%),采用替代物植入31例(21.8%)。142例患者中有132例(93.0%)行同期修复,6例(4.2%)行延期修复,4例(2.8%)选择Ⅰ期暂时性修复后Ⅱ期再次修复。结论各类下颌骨缺损应考虑同期修复重建。应结合患者的多种因素综合考虑选择修复重建的方法。血管化骨移植是理想的修复方法,但并非适合所有患者。自体游离骨移植适合临床常规应用,但适用范围受局限。替代物植入可作为补充方法,但不应作为临床常规首选。

Objective To analyse various kinds of mandibular reconstruction methods in clinic, evaluate the application of these methods and analyze the time of mandibular reconstruction. Methods 142 cases of mandibular reconstruction following tumour dissection in hospital from December 1994 to December 2007 were collected.Factors including domestic economy,lack of soft tissue,pathological changes and chemotherapy/radiotherapy that related to the methods selection of mandibular reconstruction were recorded and analyzed. The mandiblular defects were classified based on the HCL classification and the mandibular reconstruction methods and time selection were compared. Results 142 patients underwent mandibular reconstruction were collected, in whom 103 （72.6%） patients underwent autogenous free bone transplantation, 8 patients underwent free vascularized bone transplantation, 31 （21.8%） patients underwent substitution insertion. 132（93.0% ） patients underwent immediate mandibular reconstruction,6（4.2%） patients underwent delayed mandibular reconstruction, 4 patients underwent secondary mandibular reconstruction after temporary reconstruction. Conclusion Immediate mandibular reconstruction is possible in nearly all mandibular defects. The methods selection of mandibular reconstruction should be based on careful consideration of many cardinal variables. Vascularized bone transplantation is an ideal method, but not necessary in all patients. Autogenons free bone transplantation represent a good outcome based on careful patients selection.Substitution insertion is an alternative method,but not advocated as the first selection routinely.