自体骨移植修复颧骨颧弓截骨术后骨不连的临床研究

Reconstruction of nonunion malar by autogenous bone graft

目的 探讨采用口内入路及耳前小切口自体骨移植修复颧骨、颧弓截骨术后骨不连的临床疗效。方法 自2015年1月至2017年12月,对收治的9例颧骨、颧弓截骨术后骨不连患者,采用口内入路结合耳前小切口手术治疗;供骨区域选择自体颧骨、下颌角外板、髂骨等部位。自体骨移植后用钛板钛钉行坚固内固定。结果 所有患者颧骨、颧弓断端术后均获得良好的骨愈合,移植骨成活良好。随访3～24个月,均未发生严重的并发症,外观效果较满意,面部无可见瘢痕。结论 截骨过多、对合不齐及固定不良是发生颧骨、颧弓骨不连的主要原因。采用口内入路及耳前小切口自体骨移植修复颧骨、颧弓截骨术后骨不连的临床效果优异,创伤小,切口较隐蔽,安全可靠。

Objective To evaluate the effect of autogenous bone graft of intraoral approach and preauricular small incision in malar nonunion after zygomatic osteotomy. Methods From January 2015 to December 2017, 9 patients with malar nonunion after zygomatic osteotomy for prominent malar complex were treated in our department. All patients were treated by autogenous bone graft by using a malar bone, outer mandibular plate, or iliac bone. Titanium plates and titanium nails were used for internal fixation. Results All zygomatic bone and zygomatic arch fractures were well healed, and transplanted bone were well survived postoperatively. The patients were followed up for 3 to 24 months, during which time no serious complications occurred. The appearance was satisfactory. There was no visible scar on the face. Conclusion Excessive osteotomy, improper alignment, and poor fixation are the main causes of nonunion of the zygomatic bone and zygomatic arch. Autogenous bone graft combined with rigid internal fixation is an effective and safe method for the treatment of malar nonunion after zygomatic osteotomy for prominent malar complex.