下颌骨缺损重建的应用与进展

Application and progress of mandibular reconstruction

背景:目前有多种修复方法可以应用于临床下颌骨修复重建,但在修复过程依然存在一些问题有待解决。目的:总结下颌骨缺损重建的方法及进展,面临的难题,展望下颌骨缺损重建的发展方向。方法:由第一作者用计算机检索PubMed数据库、万方数据库和CNKI数据库1985年至2017年有关下颌骨缺损重建进展的文献,并进行筛选、归纳和总结。英文检索词为"Mandibular reconstruction;bone tissue engineering;prosthesis device;operative complications",中文检索词为"下颌骨重建;骨组织工程;修复体装置;术区并发症"。从下颌骨缺损的分类、重建方法等方面进行总结,探讨下颌骨重建存在的难题及未来发展方向。结果与结论:纳入文献48篇。(1)下颌骨缺损较为复杂,合理的缺损分类是下颌骨修复重建和临床治疗的关键;(2)对于因肿瘤切除导致的下颌骨缺损,快速修复更有利于面部外形和功能恢复,已逐步获得认可;(3)目前下颌骨缺损重建的常用方法主要包括非血管化骨移植和血管化骨移植等,但手术创伤大,并发症的发生,难以恢复咬合重建等是困扰临床医生的难题。快速成型技术、计算机辅助设计与制造技术的出现,不仅实现了手术的精确度,还显著缩短了手术时间,使患者获得良好的重建效果;(4)组织工程技术在下颌骨缺损重建修复方面具有广阔的应用前景,其与计算机辅助设计与制造技术的结合,能够实现下颌骨功能和形态的修复,但是对于大块下颌骨缺损修复的长期效果评估仍需进一步研究。

BACKGROUND:There are various methods used for mandibular reconstruction,but some problems still need to be solved.OBJECTIVE:To summarize the methods,research progress,and existing problems of mandibular reconstruction,and forecast the future development.METHODS:The“mandibular reconstruction,bone tissue engineering,prosthesis device,operative complications”in English and Chinese served as the keywords to search the articles related to the research progress of mandibular reconstruction published from1985to2017in PubMed,WanFang and CNKI databases.The classification of mandibular defects,reconstruction methods were summarized,and the existing difficulties and development direction were explored.RESULTS AND CONCLUSION:Totally48eligible articles were enrolled.Considering that mandibular defects are complicated,an appropriate classification method is crucial for mandibular reconstruction and treatment.Immediate reconstruction is recommended for mandibular defects caused by tumor resection,which has been shown to be available for the recovery of facial appearance and function.Non-vascularized and vascularized bone grafts are commonly used for mandibular reconstruction,but large surgical trauma,complications and difficulty in occlusal relationship still trouble clinical surgeons.Those emerging technologies,such as rapid prototyping,computer aided design and computer aided manufacture,not only enhance the surgical precision,but also remarkably reduce the operation time,further achieving satisfactory reconstructive effects.Tissue engineering is a promising method in the reconstruction of mandibular defects,and its combination with computer aided design and computer aided manufacture can perfectly restore the mandibular function and morphology.However,the long-term efficacy in the repair of mandibular defects needs to be studied in depth.