肿瘤术后颌骨缺损的功能重建

Functional implantation reconstruction of acquired jaw defects after tumor resection

目的 肿瘤术后造成的颌骨缺损使患者丧失咀嚼、语言等功能 ,并导致颜面畸形。采用植骨种植功能颌重建 ,以提高患者的生存质量。方法 本组 64例肿瘤术后颌骨缺损 (上颌 1 0例 ,下颌 54例 )所用 3种方法 :①下颌骨部分或全部缺损 ,采用血管化或非血管化骨移植延期 (同期 )牙种植 ,完成种植义齿修复 ;②一侧上颌骨缺损 ,健侧缺牙或无牙 ,采用健侧牙种植完成赝复修复 ;③双侧上颌骨缺损 ,采用颧骨种植 ,通过磁附着固位完成义颌赝复修复。结果 64例所用 3种方法均达到恢复外形与功能理想的效果。观察时间最长 1 2年 ,最短 5年 ,其中 6枚种植体未实现骨结合。上颌缺损修复的种植体存留率为 97 5 % ;下颌骨缺损血管化植骨种植为 97 1 % ;非血管化植骨种植为97 7%。结论 上颌骨缺损采用种植赝复修复可行 ,若颧骨较薄 ,应先植骨 ;植骨 种植是下颌骨功能重建理想的方法。血管化植骨种植适用于植骨床血运差的患者 ;非血管化植骨种植方法简单 ,易于推广。因缩短了移植骨的离体时间 ,骨细胞仍有活性 ,与血管化骨移植效果一致。证实了自体骨植骨块兼有骨形成。

Objective Partial or full defects of jawbone following tumor resection frequently lead to a loss of mastication, an impaired speech function and a severe deformity of appearance. To improve the life quality of such patients, implantation or bone grafting combined implantation was utilized to functionally reconstruct the jaw defects. Methods 1. Fragmental or full mandibular defects were reconstructed by vascularized or non vascularized bone grafts in combination with immediate or delayed implants. 2. The unilateral maxillary defect with an edentulous counter side was rehabilitated by a prosthesis secured on implants placed on the healthy side. 3. For bilateral maxillary defect, implants were placed in the zygmatic bone or augmented zygmatic bone to support a prosthesis with magnetic retention. Results 64 jaw defects (10 in maxilla; 54 in mandible) were reconstructed by three different methods torestore the appearance and functions. The longest follow up period was 12 years and the shortest 5 year, only 6 implants were lost due to failure of osseointegration. The implant survival rate for the maxillary defects was 97 5%, for the mandibular defects with vascularized bone grafts was 97 1%, and with non vascularized bone grafts was 97 7%. Conclusions Implants borne prosthesis is an applicable technique in restoration of maxillary defects. In case of insufficient zygomatic thickness, bone augmentation is often needed prior to implantation. As for the mandibular reconstruction, bone grafting in combination with implantation is an ideal method. Compared to non vascularized bone grafting, the vascularized method is much more suitable for bone grafting beds with poor blood supply. From the practical point of view, non vascularized bone graft in combination with implantation is more practicable. The reduced off body time of bone grafts from donor to recipient site keeps most of osteoblasts vital and enables simultaneous implants to achieve osseointegration. This confirms the osteogenesis, osteoconduction and osteoinduction of bone autografts.