血管化髂骨瓣重建下颌骨有牙区缺损时髂骨嵴不同朝向的优缺点比较

Comparison of advantages and disadvantages of iliac crest in different orientations for reconstruction of dentulous defect of mandible with vascularized iliac bone flaps

目的 :通过比较髂骨嵴不同朝向重建下颌骨缺损后的对称性和是否符合种植牙治疗标准,分析血管化髂骨瓣重建下颌骨有牙区缺损时髂骨嵴不同朝向的优缺点。方法:回顾2017年1月—2019年12月于北京大学口腔医院行髂骨瓣重建下颌骨缺损的患者的基本信息和术后CT资料,根据髂骨嵴的朝向分为髂骨嵴朝向牙槽突组和髂骨嵴朝向下颌骨下缘组。CT影像资料导入Proplan软件,测量2组髂骨重建后的对称性;导入Simplant软件,测量髂骨骨块长度,相对于患侧上颌1、3、6牙3个位点对应的髂骨高度、牙槽突侧骨宽度以及颌间距离。采用SPSS 25.0软件包对数据进行统计学分析。结果:30例患者纳入研究,每组各15例,平均年龄37.7岁。LC缺损类型在颏孔点下缘位置朝向牙槽突组非对称率(4.9%)显著小于朝向下颌骨下缘组(18.2%,P<0.05)。朝向牙槽突组和朝向下颌骨下缘的骨长度分别为(49.43±4.17)mm、(52.25±3.79)mm(P=0.102)。相对于患侧上颌1、3、6位点的牙槽突侧髂骨骨宽度朝向牙槽突组分别为(11.40±0.63)、(12.15±0.46)、(13.15±0.62)mm,均显著大于朝向下颌骨下缘组的(7.93±0.55)、(8.97±0.34)、(8.70±0.49)mm(P<0.05);相对于上颌6位点的髂骨骨高度在朝向牙槽突组为(29.80±1.17)mm,显著大于朝向下颌骨下缘组的(25.42±1.17)mm(P<0.05)。相对于上颌6位点的颌间距离,朝向牙槽突组为(10.89±1.07)mm,显著小于朝向下颌骨下缘组的(14.33±0.76)mm(P<0.05)。结论:在血管化髂骨瓣修复重建下颌骨有牙区缺损时,髂骨嵴朝向牙槽突侧较髂骨嵴朝向下颌骨下缘侧有更好的对称性,更充足的牙槽嵴宽度及更合适的颌间距离。

PUEPOSE: In this study, the symmetry of neomandible and whether meeting the standard of dental implant after reconstruction with iliac bone flap were measured to make sure the advantages and disadvantages of different iliac crest orientations. METHODS: Patients who underwent mandibular defect reconstruction with iliac bone flap at Peking University School and Hospital of Stomatology from January 2017 to December 2019 were included in this study, and divided into iliac crest oriented to alveolar process group(group A) and iliac crest oriented to lower mandibular margin group(group B). The patients’ basic information and CT image data after operation were collected. Simplant and Proplan software were used to measure the symmetry, the length of bone segment, the height, the width of alveolar process side and the distance between jaws and iliac crest after reconstruction(opposite to upper incisor,canine and first molar). The data was analyzed using SPSS 25.0 software package. RESULTS: There were 15 patients in group A and B respectively, the average age was 37.7 years old. The asymmetry rate of LC defect type at the lower edge of the mental foramen in group A was less than that in group B. There was no significant difference in bone length between group A(49.43±4.17)mm and group B(52.25±3.79)mm. The widths of occlusal side in group A(opposite to upper incisor, canine and first molar) were(11.40±0.63),(12.15±0.46),(13.15±0.62)mm, and(7.93±0.55),(8.97±0.34),(8.70±0.49)mm(P<0.05) in group B, respectively. The bone height opposite to upper first molar was(29.80±1.17)mm in group A, which was significantly higher than(25.42±1.17)mm in group B(P<0.05). The intermaxillary distance of group A was less than that of group B, the distance of first molar was(10.89±1.07)mm in group A and(14.33±0.76)mm in group B(P<0.05). CONCLUSIONS: When mandibular dentulous defect is reconstructed with vascularized iliac bone flap, the iliac crest oriented to the alveolar process side can get better symmetry, wider alveolar ridge and more suitable intermaxillary distance than iliac crest oriented to the lower margin of the mandible.