腓骨及髂骨组织瓣在修复下颌骨缺损的应用比较研究

Comparision of Fibula and Lliac Free Flaps for Mandibular Defects

目的:比较腓骨和髂骨组织瓣在修复下颌骨缺损的临床应用效果。方法:采用血管化腓骨瓣修复下颌骨缺损12例;应用髂骨瓣修复下颌骨缺损19例,其中血管化骨瓣5例,非血管化骨瓣14例。结合坚固内固定方法恢复下颌骨的形态及功能。结果:血管化腓骨瓣全部成活,骨组织改建良好,下颌骨外形及功能满意,未发现供区组织功能明显障碍。5例血管化髂骨瓣中3例成活,2例血管化失败。另14例非血管化髂骨瓣中有4例出现受区伤口感染。非血管化骨瓣骨组织改建缓慢。髂骨瓣移植患者下颌骨外形恢复欠佳,供区有不同程度的功能障碍。结论:血管化骨组织瓣移植其骨组织改建快速、稳定,抗感染能力强。血管化腓骨瓣移植因血管吻合成功率高、取骨量充分且可多点截骨塑形重建、供区并发症少等优点,是下颌骨缺损修复的最佳方法之一。

Objective： To compare the usage of fibula and iliac free flaps for mandibular reconstruction. Methods： A retrospective study was made on 31 cases who were treated with fibula and iliac free flaps reconstruction for man- dibular segmental dissection. The complications and effect of the two groups were compared. Results： 12 vascular- ized fibula and 3 vascularized iliac free flaps survived well. The bone grafts underwent little resorption. All patients were satisfied with their facial symmetry. There were 2 vascularized iliac free flaps failed. Four of the nonvascular- ized iliac grafts underwent recipient area infection. Conclusion： Vascularized fibula free flap with advantages of high success rate of vascular anastomosis, sufficient bone mass, multipoint osteotomy reconstruction possible, less com- plications in donor areas, is the best method for reconstruction of mandibular defects.