下颌骨缺损重建术后钛板相关并发症97例临床回顾研究

Plate related complication after mandibular reconstruction

目的 分析下颌骨节段性缺损患者的重建修复术后钛板相关并发症及其影响因素.方法 回顾性分析660例病例中导致颌骨缺损的原因主要有鳞状细胞癌205例（31.1％）、成釉细胞瘤198例（30.0％）；下颌骨缺损类型以不包括髁突缺损的一侧下颌骨不超过中线的任何长度缺损为主,共324例（49.1％）.按照修复方式分为骨移植修复组（600例）和非骨移植修复组即重建钛板桥接修复组（60例）.分析660例下颌骨节段性缺损患者颌骨缺损的病因、缺损类型、术后钛板相关并发症及其影响因素.结果 整体术后钛板相关并发症的发生率为14.7％ （97/660）,其中钛钉松动5.8％ （38/660）、钛板折断3.3％（22/660）、钛板外露3.8％（25/660）、术后感染7.4％（49/660）、骨愈合不良或不愈合2.9％（19/660）.骨移植修复组并发症发生率11.0％（66/600）显著低于重建钛板桥接修复组51.7％ （31/60）.骨移植＋小型钛板修复组术后并发症发生率为10.8％（63/586）.腓骨＋小型钛板修复组术后钛钉松动位置集中在髁突-腓骨连接处、下颌角-腓骨连接处以及下颌角两腓骨连接处.放疗、糖尿病史与术后并发症有关,钛板外露与放疗关系显著（P值=0.000）.结论 骨移植重建下颌骨可以有效减少术后并发症；放疗、糖尿病史与术后并发症有关.

Objective To evaluate the complications and factors associated with titanium plates in mandibular reconstruction with different methods.Methods A retrospective analysis of 660 patients who received primary reconstruction of the mandible was conducted.The characters of the mandibular defect and methods of reconstruction were recorded.The complications and factors associated with the reconstruction were analyzed.Results The majority of mandibular defect was in a shape of L （n =324）.The total complication rate was 14.7% （97/660）,which included screw loosening 5.8% （38/660）,plate fracture 3.3% （22/660）,plate exposure 3.8% （25/660）,infection 7.4% （49/660） and malunion or ununion 2.9% （19/660）.The mandibular defects reconstructed by reconstructive plates had a higher complication rate than that by bone grafts.The complication rate was 10.8% （63/586）in cases reconstructed by bone grafts with miniplates.The complications were associated with radiation therapy and diabetes.Radiation therapy had a significant effect on plate exposure.Conclusions Reconstruction with bone grafts can minimize the rate of plate related complication.The complications were associated with radiation therapy and diabetes.