摘要
目的:探讨腓骨游离瓣同期修复下颌骨缺损过程中骨段的塑形与固定方法。方法:作者自1996年4月以来连续应用腓骨游离瓣修复口腔下颌骨缺损26例。依下颌骨缺损范围,将缺损分为八种类型。根据每类缺损部位及特点,对修复骨瓣进行截开、分段,参照正常下颌骨解剖形态对骨段塑形,分别用微型钛板,修复钛板,记忆合金骑缝钉或20号不锈钢丝进行固定。结果:所有骨瓣及骨皮瓣均存活,成功率100%。26例下颌骨缺损中Ⅰ类缺损4例,Ⅱ类4例,Ⅲ类4例,Ⅳ类5例,Ⅴ类2例,Ⅵ类3例,Ⅶ类3例,Ⅷ类1例。骨瓣截成4段者1例,3段者6例,2段者14例,剩余5例未分段。术后3个月摄片示仅1例分成3段者最短骨段有轻度吸收,其余骨段愈合良好。术后面形恢复优良率达85%(22/26)。结论:腓骨游离瓣可截成2~4段。截骨部位应选择在正中联合,颏体交界处和下颌角处。修复正中联合缺损时以选用小型钛板固定为宜,二段以上的骨瓣或修复升支缺损时,应选用修复钛板进行固定,钢丝结扎仅用于辅助固定。
Objective: To evaluate the shaping and fixation of fibula free flap in reconcstruction of mandibular defects.Method: 26 patients with oro mandibular defects were reconstructed with fibula free flap from April, 1996. The defects were classified into 8 types according to the resected extent. In light of location of mandibular and its feature, the fibula flaps were cut into 2-4 segments, bent to the appropriate shape near the normal mandible, and fixed with titanium mini plates, reconstruction plates, memory alloy straddling pins or stainless steel wires. Results: All the 26 osseous and/or cutaneous flaps survived with a success rate of 100%. Of these patients, 4 were type Ⅰ,4 were type Ⅱ, 4 were type Ⅲ, 5 were type Ⅳ, 2 were type Ⅴ, 3 were type Ⅵ, 3 were type Ⅶ and 1 was type Ⅷ. The fibula flaps were divided into 4 segments in one case, 3 segments in 6 cases and 2 segments in 14 cases. 3 months after surgery, good bone approximation and normal callus formation were shown by x ray films in 24 cases. Absorption of bone segment was observed only in one case. Esthetic results were excellent or good in 85% patients. Conclusions: Fibula free flap can be divided into 2-4 segments. The location of osteotomy should be at the mental symphsis, chin and body junction and mandibular angle. Titanium mini plates are suitable for fixation of bone segments for mental symphsis reconstruction. For fibula flap with more than two segments or for reconstruction of mandibular ramus, reconstruction plates should be chosen. The stainless steel wires are only used to enhance the fixation. The memory alloy straddling pins are appropriate for fixation of the fibula flap and the condylar process.
出处
《口腔颌面外科杂志》
CAS
1999年第1期46-50,共5页
Journal of Oral and Maxillofacial Surgery
关键词
腓骨瓣
下颌骨重建
骨固定
Surgical flap Fibula free flap Mandibular reconstruction Bone fixation