腓骨双叠结合钛种植体重建下颌骨大型缺损的临床研究

Clinical research on the rebuilding of large mandibular defects via the integration of double-fold fibula and tiimplant

目的探讨下颌骨大型缺损后,采取腓骨肌皮瓣双叠结合II期种植义齿修复重建患者咬合功能,并评估修复后患者面部外形、咀嚼功能的临床效果。方法对6例因肿瘤切除部分下颌骨而造成下颌骨大型缺损的患者行腓骨肌皮瓣双叠移植术,术前通过CT扫描及Simplant软件重建缺损下颌骨并在计算机上设计和定位腓骨肌皮瓣的塑形位点及进行术前模拟,术后观察1年,无复发者II期通过软件设计种植位点并制作种植导板,辅助种植体植入,种植手术3个月后行义齿修复,定期随访,并测定患者种植义齿咀嚼功能、指导义齿护理。结果 6例游离腓骨肌皮瓣全部成活,1年后无复发,II期种植体植入后与移植骨骨性结合,5例义齿修复后面部外形对称、咬合关系良好、临床效果满意,测定咀嚼效率恢复良好,1例患者义齿修复后2个月磨牙区牙龈出现红肿疼痛,经局部冲洗及抗炎治疗1周后,炎症减轻,2周后牙龈肿胀消除、颜色恢复正常。结论腓骨肌皮瓣双叠结合种植义齿是修复下颌骨大型缺损的可靠方法之一。计算机软件辅助骨缺损及种植修复,可以有效恢复颌面部外形及功能。义齿修复后基托与牙龈之间应保持适当的距离(1.5-2mm),便于义齿清洁。义齿修复后使用牙冲洗器效果良好。

Objective Probe into the restoration of occlusion function by integrating the double-fold fibular osseo-myocutaneous flap and Phase Ⅱ implanting denture after mandibular suffers largely defects and evaluate the clinical effect of the patients＇ facial configuration and occlusion function after restoration. Methods Operate the doublefold fibular osseo-myocutaneous flap transplantation for 6 patients suffering from large mandibular defect which is caused by tumor excision. Before operation, rebuild the defective mandibular via CT Scanning and Simplant software, design and locate the shaping point where fibular osseo-myocutaneous flap is applied and carry out the pre-operation simulation.During the first year after operation, observe the health conditions of patients. In the Phase Ⅱ, facilitate the implantation of the implants via the software to decide the implanting locus and design the implanting guide plate. Three months after the implantation, the reparation of denture and regular visit to the patients should be implemented. Measure the occlusion function of the patients＇ implanted denture and guide the denture nursing. Results The dissociated fibular osseo-myocutaneous flaps for 6 patients survived, and one year after the operation, no one relapsed. Phase II implanted implants built synostosis with the bone graft. Five patients＇ face configurations were symmetric with good occluding relation and satisfied clinical effect after the reparation of denture. After measurement, the restoration of masticatory function was good.Two month after the reparation of denture, swelling and pain occurred to one of the patients＇ gingiva in the molar area.The inflammation was alleviated after one-week local brushing and anti-inflammatory treatment, and the swelling gingival was eliminated and its color became normal after the follow-up treatment in the second week. Conclusion The integration of double-fold fibular osseo-myocutaneous flap and implanting denture is one of the reliable ways to repair large mandibular defect. The assistance of computer software with the restoration of bone defect and implants can effectively restore the configuration of maxillofacial and its function. The base plate shall keep a proper distance（1.5~2mm）with the gingival after the denture is restored so that it is convenient for the cleaning of denture. The effect of teeth douche is good after the denture reparation.