上颌骨切除术与赝复体修复

Maxillectomy and restoration with maxillary prostheses

目的：改进上颌骨切除术的手术设计，为上颌骨缺损的赝复创造良好条件，以实现上颌骨缺损的最佳修复效果。方法：分别对采用变异上颌骨切除术和常规上颌骨切除术后患者的赝复体进行牙合力测定和咀嚼效能测定，对余留基牙的松动情况进行远期临床观察，比较不同方法手术后赝复体的修复效果。结果：保留了部分患侧上颌骨的患者的缺损侧赝复体平均牙合力和咀嚼效能，分别为一侧上颌骨全部切除患者缺损侧雁复体平均拾力和咀嚼效能的４倍和５．７倍；在Ａ基牙近缺损区保留了５ｍｍ左右骨壁的患者，其Ａ基牙松动率远低于采用常规一侧上颌骨切除术的患者。结论：在遵循肿瘤外科的原则的前提下，应尽可能采用变异的一侧上颌骨切除术，多保留一些上颌骨支持组织以增加对上颌赝复体的支持，利于患者咀嚼功能的重建；在Ａ基牙近缺损区侧保留５ｍｍ以上的骨组织，可有效地防止Ａ基牙松动脱落。

Objective: To improve the operative design of maxillectomy and create a better restorative condition for maxillary prostheses.Method: Occlusal force measuring, masticatory efficiency measuring, 'A ' abutment mobility following up were carried out in the patients who had been treated with modified maxillectomy and routine maxillectomy respectively. The effects of maxillary prostheses prepared after the operations were studies. Result: The average occllusal force and masticatory efficiency with the prostheses on the defect side of the patients treated with modified maxillectomy were 4 and 5.7 times stronger than that of the patients treated with routine method. Loosing rate of 'A' abutment in the patients, whose alveolar bone tissue surround 'A' abutment had been preserved more than 5mm, is far less than that of the patients whose alveolar were removed with routine method.Conclusion:Modified maxillectomy following the principle of tumor surgery can preserve more supporting tissue for the reconstruction with maxillary prostheses and for the imporvement of masticatory function, and prevent the loosing and lose of 'A' abutment.