自体骨、生物材料在颅颌面骨缺损修复中的应用研究

Autologous Bone,Biological Materials in the Application of the Craniofacial and Maxillofacial Bone Defects Repair

目的:运用自体骨与生物材料修复颅颌面骨缺损,观察临床效果并术后随访,以比较自体骨移植与生物材料植入的疗效。方法:将2006年以来笔者科室收治的各种颅颌面骨缺损129例患者分为A、B两组。A组:采用自体骨移植修复,共51例,其中带血管蒂的颅骨外板修复6例、颅骨外板修复37例、下颌骨外板修复8例;B组:采用生物材料植入修复,共78例,其中钛板(网)修复17例、Medpor修复46例、羟基磷灰石修复15例。术后随访6~72个月,通过摄相,头颅X线正、侧位片,面部轮廓测量,颌面部CT及三维重建,了解患者满意度,观察临床效果及有无后期并发症发生。结果:129例患者术后伤口均一期愈合,颅颌面轮廓得到了很大改善,同时具有很好的美容效果。自体骨修复患者中1例术后出现了血清肿,通过负压引流和加压包扎清除了血清肿后伤口一期愈合。术后随访1例Medpor修复额骨缺损患者切口边缘增生,1例Medpor修复患者固定的钛钉穿破皮肤,1例Medpor修复面中分患者修复体外露。其他患者术后随访,颅颌面骨轮廓外观正常,双侧对称,无再陷及表面凹凸不平、修复体移位、外露、假体取出等明显的并发症发生,患者对术后效果满意。结论:颅颌面骨缺损的修复首选自体骨,其中自体颅骨外板与下颌骨外板修复效果较好;当缺损面积大自体骨量不足时,考虑生物材料修复,其中Medpor、羟基磷灰石、钛板应用较多,临床效果满意。

Objective Use of autologous bone with biological materials to repair cranial and maxillofacial bone defects, observe the clinical effect, and postoperative follow-up, to compare the therapeutic effect of autologous bone implantation with biological materials. Methods Will our hospital since 2006 plastic surgery hospital were all sorts of cranial and maxillofacial bone defects in 129 patients, divided into two groups A and B. Using autologous bone graft to repair in group A, A total of 51 cases, among them with vessel pedicle of 6 patients with skull plate repair, skull plate repair 37 cases, mandibular plate repair 8 cases. Group B with biological materials implanted repair, a total of 78 cases, including titanium plate （net） repair of 17 cases, 46 cases of Medpor repair, hydroxyapatite to repair 15 cases. Postoperative follow-up of 6 months to 72 months, by cameras, skull X-ray, side slice, facial contour measurement, maxillofacial CT and three-dimensional reconstruction, understand the patient satisfaction, observe the clinical effect and the presence of late complications. Results 129 patients of postoperative wound healing stage I, Cranial and maxillofacial contour got very big improvement, also has the very good cosmetic effect. No serious infection, restorative materials exposed, such as fixed prosthesis to take out the serious complications. Autologous bone repair in patients with postoperative seroma, 1 patients through the negative pressure drainage and compression bandage cleared seroma, stage I wound to heal. Biological materials to repair 1 patients in postoperative incision in patients with local convex edge is higher than the lateral plane, improve local hyperplasia after reduce stimulus compression bandage, postoperative effect is satisfactory. Conclusion Cranial and maxillofacial bone defect repair preferred autologous bone： the autologous skull plate with mandibular plate repair effect is better; When the defect area is large autologous bone deficiency, consider biological materials to repair, which Medpor, hydroxyapatite and application of titanium plate is more, clinical effect is satisfactory.