腓骨游离瓣重建下颌骨的骨段塑形与固定方法

SHAPING AND FIXATION OF FIBULA FREE FLAP IN RECONSTRUCTION OF MANDIBULAR DEFECTS

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.