肿瘤术后下颌骨缺损的成型钛板即刻修复重建

目的研究下颌骨肿瘤切除后成型钛板即刻修复重建的手术方法和临床效果。方法根据患者下颌骨缺损范围及有无软组织缺损采用不同的修复方法,纯钛自动压缩重建固定板4例,纯钛下颌人工关节14例,并对不同缺损骨段修复重建后的面部形态和咬合关系进行比较。结果14例一侧下颌骨缺失成型钛板即刻重建取得良好的效果;而4例超越中线的下颌骨体缺失患者的效果不佳。结论成型钛板是修复一侧下颌骨缺失的良好的替代材料。     

基于三维CT重建的快速成型技术在下颌骨重建的临床应用

目的 评价基于三维CT重建的快速成型技术在下颌骨重建中的作用。 方法 本组选取7例下颌骨病变病例,术前均采用基于三维CT重建的快速成型技术,制作下颌骨实体模型,并在实体模型上设计下颌骨切骨范围和拟用髂骨瓣或腓骨瓣的骨量和形态。术中按拟定方案切除下颌骨病变,并同期以钛板、血管化游离腓骨瓣或髂骨瓣修复下颌骨缺损,术后定期观察随访。 结果 采用游离髂骨瓣移植修复者3例,游离腓骨瓣移植者3例,单纯以重建钛板固定者1例。移植骨块均顺利成活。已随访6个月~2年。下颌骨形态和面型基本对称,无下颌偏颌。余留牙咬合关系同术前,张口度正常,咀嚼和语音功能恢复良好。 结论 基于三维CT重建的快速成型技术为下颌骨缺损的个体化和功能性修复提供良好桥梁。     

UniLOCK 钛板在下颌骨缺损的功能性重建中的应用

目的:观察UniLOCK钛板在下颌骨缺损修复重建中的应用效果。方法:收集2003、2004年第四军医大学口腔医学院行口腔颌面肿瘤术后钛板即刻修复者42例,术后复查。结果:42例中,除1例因术后感染去除钛板外,均愈合良好,较好地重建了下颌骨的连续性及功能。结论:UniLOCK钛板用于下颌骨缺损的重建可以有效的恢复咬合关系与面形。     

基于快速成型技术即刻精确修复下颌骨缺损的临床研究

目的：探索应用快速成型技术对下颌骨部分缺损进行即刻、精确与功能性修复的方法。方法：5例下颌骨缺损需即刻行外形和功能修复的患者,先行三维CT扫描获得颌面部影像数据,在计算机内进行三维重建;应用快速成型技术制作颌面部实体模型,在模型上进行模拟外科,确定手术部位、截骨点、重建钛板的方向和角度;同时,制作出缺损区骨质的树脂模型,指导修整移植骨块。术中,切除部分下颌骨后,根据术前模拟的方案,进行血管化的髂骨移植加重建钛板固定,或者单纯重建钛板固定。结果：5例下颌骨病变切除后均即刻行修复重建治疗。手术过程明显快捷、顺利,移植骨和重建钛板均简单修整即就位植入,术后患者的双侧面形对称,余留牙咬合关系良好、稳定,医患满意度均较高。结论：应用快速成型技术,对精确、快速地修复下颌骨缺损、恢复面部对称性、重建咬合功能等,是一种简便、有效、可推广的方法。     

胸锁乳突肌肌皮瓣结合重建钛板同期修复下颌骨缺损

目的：探讨胸锁乳突肌肌皮瓣配合重建钛板同期修复口腔恶性肿瘤术后下颌骨缺损的临床效果。方法：对26例因口腔恶性肿瘤扩大切除术截除部分下颌骨的患者,采用胸锁乳突肌肌皮瓣配合重建钛板同期修复。术后3个月至5年门诊随访。结果：25例患者术后Ⅰ期愈合,肿瘤无复发,面型基本对称,咬合关系良好,张口度正常。结论：采用胸锁乳突肌肌皮瓣配合重建钛板同期修复口腔恶性肿瘤术后下颌骨缺损,临床效果良好。     

应用重建钛板即刻修复下颌骨节段性缺损的临床研究

目的：观察重建钛板即刻修复下颌骨节段性缺损的临床效果。方法：下颌骨节段性缺损患者40例,用重建钛板即刻修复,术后定期复查,对面部外形,咬合关系,颞颌关节功能,开口度,并发症等进行回访评价。结果：本组病例中,37例愈合良好,恢复了下颌骨的连续性及功能,1例发生金属钛板外露,1例发生口内瘘,1例发生骨瓣缺血坏死并肿瘤复发。结论：应用重建板钛即刻修复下颌骨节段性缺损,在功能和外形方面,大多可以获得良好效果,是目前较好的修复方法。     

下颌骨节段性缺损541例临床回顾性研究

目的对下颌骨节段性缺损患者临床特点和治疗方法进行回顾和分析，为下颌骨个复重建提供理论依据和指导。方法 分析541例下颌骨节段性缺损患者的一般情况、下颌骨缺损原因、缺损部位、修复重建方法及并发症。结果541例下颌骨缺损中，肿瘤是导致缺损的主要原因；缺损中以不超过中线的一侧缺损为主要类型（426例，占下颌骨体部缺损的82.4%）。修复方法包括直接关闭创口、单纯软组织瓣修复、单纯钛板修复、钛板＋软组织瓣修复和骨瓣修复，其中骨瓣修复（234例）、钛板＋软组织瓣修复（103例）及单纯软组织瓣修复（142例）是最常的修复方法。最常见的局部并发症是感染或瘘道（55例），感染率10.2%。结论本组下颌骨缺损患者的年龄颁布与以往的有关报道相似，肿瘤是缺损主要原因，下颌骨体部是最容易累及的缺损部位，大部分缺损中包含软组织缺损下颌骨复合缺损，在诸多修复方法中，血管化的自体骨组织瓣移植已经成为下颌骨重建的主要方法。口腔颌面肿瘤患者在骨组织重建的同时，相邻软组织的重建应引起足够重视。     

下颌重建钛板即刻修复下颌骨缺损26例

目的 总结下颌重建钛板即刻修复下颌骨缺损的临床治疗效果。方法 对26例下颌骨部分切除后术中钛板即刻重建的患者进行回顾性分析。结果 26例患者中,2例术后半年内死于恶性肿瘤转移,1例因肿瘤复发而再次手术,1例放射性骨髓炎术后伤口延期愈合,其余均愈后良好,患者面形恢复满意,保存了部分咀嚼功能。结论 下颌重建钛板即刻修复下颌骨缺损是一种简单实用,效果可靠的方法。     

钛重建板修复下颌骨缺损的临床应用

目的：研究钛重建板在修复下颌骨缺损,维持下颌骨连续性和面部形态的临床意义。方法：收集我科自1999～2004年口腔颌面部肿瘤患者,在行根治合并下颌骨部分切除术后,用钛重建板即刻修复,对饮食功能、面部形态恢复及并发症的发生进行回访评价。结果：回访中,对于功能和外形．有21例病人成功维持了下颌骨的连续性,并有20例病人能饮食一般性食物．患者的开口度和开口型基本正常：对于并发症．有2例发生金属外露和1例发生钛重建板折断,均发生在手术半年以后：结论：钛重建板即刻修复下颌骨缺损,在功能和外形方面,大多可以获得良好效果,是一种切实可行的选择性方法。     

腓骨游离瓣重建下颌骨的骨段塑形与固定方法

目的：探讨腓骨游离瓣同期修复下颌骨缺损过程中骨段的塑形与固定方法。方法：作者自１９９６年４月以来连续应用腓骨游离瓣修复口腔下颌骨缺损２６例。依下颌骨缺损范围,将缺损分为八种类型。根据每类缺损部位及特点,对修复骨瓣进行截开、分段,参照正常下颌骨解剖形态对骨段塑形,分别用微型钛板,修复钛板,记忆合金骑缝钉或２０号不锈钢丝进行固定。结果：所有骨瓣及骨皮瓣均存活,成功率１００％。２６例下颌骨缺损中Ⅰ类缺损４例,Ⅱ类４例,Ⅲ类４例,Ⅳ类５例,Ⅴ类２例,Ⅵ类３例,Ⅶ类３例,Ⅷ类１例。骨瓣截成４段者１例,３段者６例,２段者１４例,剩余５例未分段。术后３个月摄片示仅１例分成３段者最短骨段有轻度吸收,其余骨段愈合良好。术后面形恢复优良率达８５％（２２／２６）。结论：腓骨游离瓣可截成２～４段。截骨部位应选择在正中联合,颏体交界处和下颌角处。修复正中联合缺损时以选用小型钛板固定为宜,二段以上的骨瓣或修复升支缺损时,应选用修复钛板进行固定,钢丝结扎仅用于辅助固定,记忆合金骑缝钉适用于骨瓣与髁突的固定     

微孔钛网应用于犬牙槽骨增量术中的实验研究

目的探究微孔钛网在犬下颌牙槽骨增量术中的作用效果。方法选择6只成年健康杂种犬,建立双侧下颌牙槽骨缺损动物模型。将每只犬的左侧下颌牙槽骨缺损区作为第Ⅰ组,右侧作为第Ⅱ组。两组均采用GBR+自体骨修复牙槽骨缺损,第Ⅰ组采用微孔钛网,第Ⅱ组采用海奥口腔修复膜。观察植骨术后4周、8周、12周时两组大体标本、Masson染色、HE染色、荧光素标记、CT三维重建后骨微结构参数的结果。结果术后12周第Ⅰ组及第Ⅱ组植骨区域表面均形成明显新生软骨组织,移植骨与原骨之间界限模糊,其中第I组新生成骨面积略大于第Ⅱ组,新生成骨形态略优于第Ⅱ组,其它方面大体标本上肉眼观察结果差异不明显,两组牙槽嵴高度比较也无显著差异(P>0.05)。Masson染色及HE染色显示两组均有明显新生骨组织、骨小梁生成。术后12周两组骨矿化率比较无显著差异(P>0.05)。术后12周两组骨小梁数量、骨小梁厚度、骨体积比较也无显著差异(P>0.05)。结论微孔钛网在犬下颌牙槽骨缺损的GBR手术中能获得良好成骨效果,临床中可根据患者具体情况,合理应用。     

Material analysis of AO plate fracture cases.

PURPOSE: The clinical observation of fracture cases and material evaluation of fractured titanium plates were performed to investigate the causes of fracture. PATIENTS AND METHODS: Fracture of titanium plates occurred in 4 patients of the 110 mandibular reconstructions. We clinically and experimentally evaluated plate fracture cases among cases in which primary reconstruction using titanium plates was performed after the mandibular resection. RESULTS: Titanium plate fracture was frequently observed in L-type defect cases in which angle-type plates were used, and fracture mainly occurred in the anterior region of the mandibular angle. Material analysis suggested that the occurrence of fracture can be prevented by eliminating constricted parts on the internal side of the plates. CONCLUSIONS: The causes of fracture were thought to be the use of plates under the conditions of comparatively frequent repeated application of stress or fatigue fracture caused by stress concentration, depending on the form of the plate.     

Titanium lymph node pigmentation in the reconstruction plate system of a mandibular bone defect

A case of titanium pigmentation that involved a submandibular lymph node is reported. A 41-year old man had been treated for ameloblastoma by partial resection of the mandible followed by reconstruction with the use of a titanium plate to bridge the mandibular defect. Titanium pigmentation occurred in the surrounding soft tissue adjacent to the plate and within a submandibular lymph node 2 years after reconstruction.     

Prototyped grafting plate for reconstruction of mandibular defects

To esthetically and functionally restore a 40-mm canine mandibular discontinuity defect using a custom-made titanium bone-grafting plate in combination with autologous iliac bone grafts. Individualized titanium bone-grafting plates were manufactured using a series of techniques, including reverse engineering, computer aided design, rapid prototyping and titanium casting. A 40-mm discontinuous defect in the right mandibular body was created in 9 hybrid dogs. The defect was restored immediately using the customized plate in combination with autologous cancellous iliac blocks. Sequential radionuclide bone imaging was performed to evaluate the bone metabolism and reconstitution of the grafts. The specimens were evaluated by biomechanical testing, 3-dimensional microcomputed tomographic scanning, and histological examination. The results revealed that the symmetry of the mandibles was reconstructed using the customized grafting plate, and the bony continuity of the mandibles was restored. By 12 weeks after the operation, the cancellous iliac grafts became a hard bone block, which was of comparable strength to native mandibles. A fibrous tissue intermediate was found between the remodelled bone graft and the titanium plate. The results indicate that the prototyped grafting plate can be used to restore mandibular discontinuous defects, and satisfactory aesthetical and functional reconstruction can be achieved.     

系列数字化导板在腓骨肌皮瓣修复下颌骨缺损中的初步应用

目的:将系列数字化导板用于腓骨肌皮瓣修复下颌骨缺损,实现下颌骨缺损的个体化精确修复。方法:10例腓骨肌皮瓣修复下颌骨缺损的患者,男性7例,女性3例,均行术前规划,并3D打印系列数字化导板,术中应用数字化导板精确重建下颌骨,术后利用图像融合技术评价术后效果。术后所有病例未出现相关并发症。结果:系列导板术中就位顺利,重建钛板及髁状突位置准确,面型及咬合关系恢复良好。术后图像融合显示,剩余下颌骨与患侧髁状突术后位置与术前相比误差<2 mm。结论:系列数字化导板在重建下颌骨形态、保证髁状突的位置、恢复咬合关系、减少手术时间方面具有优越性。     

Evaluation of a novel osteosynthesis plate system for mandibular defects

Continuity defects of the jaw can be reconstructed with titanium plates or microvascular bone flaps; osteosynthesis plates are necessary for both. In this study we performed a retrospective review of patients treated with Medartis MODUS® Mandible Trauma/Reco 2.0-2.5, TriLock bridging plates, mandibulectomy and soft tissue free flap or reconstruction with a bony free flap and TriLock mandibular plates from the same system from January 2015 to August 2019. The variables recorded were sex, age, diagnosis, radiotherapy, date of implantation, date of explantation or death of patient, size of mandibular defect, Jewer classification of defect, number of screws used, segments of bony reconstruction, screws per segment, plate exposure, plate breakage, and pseudarthrosis. The bridging plate group consisted of 41 patients, while the mandibular plate group consisted of 24 patients. The percentage of plate exposure was 17.07% for the bridging plate group and 4.17% for the mandibular plate group. Plate breakage was 0 in both groups. Pseudarthrosis was 4.17% in the mandibular plate group. In the bridging plate group, an anterolateral thigh flap covered all exposures. Of 7 plate exposures, 4 were found in a C defect. The complication rate of the investigated plates was lower than the complication rates of other plate systems.     

Reconstruction of large defects postmandibulectomy for oral cancer using plates and myocutaneous flaps: a long-term follow-up

A series of 28 consecutive cases of mandibular reconstruction by means of reconstructive plates and myocutaneous flaps were reviewed. In all cases mandibular resection was indicated for treatment of squamous cell carcinoma of the oral cavity: 25 pelviglossomandibulectomies (resulting in large defects from the angle of the mandible), 2 Commando operations (resulting in lateral defects) and 1 anterior sectional mandibulectomy (resulting in an anterior defect). Tumour stages were T1-T2 (4 cases) and T3-T4 (24 cases). Success was defined as plate maintenance 6 months' postoperatively/postradiotherapy. The overall success rate was 32.2%. Lateral-centre-lateral (L-C-L) defects had 32% success, L (lateral) defects had 50% success and in the single case of a C (centre) defect, the plate was not maintained. Stainless steel reconstruction plates showed a similar success rate as titanium plates (30% versus 34%). In cases not submitted to radiotherapy there were more maintained plates than in cases that received radiotherapy (45.5% versus 23.6%). Reconstruction plates are not effective in bridging large defects of the resected mandible. Only in selected cases that are not eligible for microvascular free flaps should plates and myocutaneous flaps be considered as an option for mandibular reconstruction.