下颌骨缺损钛板修复后的放射治疗

目的　观察放疗对口腔癌根治术后下颌骨缺损钛板即刻修复的影响。方法　对 1997年 1月至 2002年 5月 58例下颌骨缺损钛板修复患者的放疗反应、并发症观察分析,并分析研究影响钛板修复的因素。放疗组 30例,放疗剂量 4 050~6 540cGy(平均 5 495cGy),钛板在放射野内受到全程照射。结果　放疗组 6例局部感染和瘘管形成, 5例钛板外露;对照组 4例局部感染和瘘管形成, 3例钛板外露。放疗组 6例、对照组 4例因局部感染在术后 4~15个月手术取出钛板,术后放疗组下颌骨缺损钛板立即修复成功率为 80 0% (24 /30),对照组为 85 7% (24 /28)。两组差异无统计学意义(P>0 05)。结论　下颌骨缺损钛板修复后可以进行放疗。     

穿腮腺手术径路治疗下颌骨髁突骨折的临床效果评价

目的评价穿腮腺手术径路治疗下颌骨髁突骨折的临床效果。 方法对31例（共36侧）下颌骨髁突骨折的患者,穿腮腺入路行下颌骨髁突骨折切开复位钛钉钛板坚固内固定术、髁突骨折碎片取出术并髁突成形术。术后观察面型、张口度、咬合关系、面神经损伤、有无唾液腺瘘及复查颌面部CT观察骨折段的复位情况等。 结果24例（共29侧）行下颌骨髁突骨折切开复位钛钉钛板坚固内固定术,7例（共7侧）髁突骨折碎片取出术并髁突成形术,术后随访6 ~ 18个月（平均11.3个月）;通过穿腮腺手术径路骨折断端复位准确、固定良好、咬合功能恢复正常、面部外形均满意;4例患者早期出现Ⅰ~Ⅱ度张口受限,经过张闭口训练后恢复正常;5例患者出现面神经暂时性麻痹,8周后均恢复正常;1例患者出现唾液腺瘘,经过加压包2周后扎后创口愈合;4例患者出现创伤性关节紊乱症,有关节弹响、疼痛等。 结论穿腮腺手术径路治疗下颌骨髁突骨折安全有效,手术并发症少,值得临床推广应用。     

双侧下颌骨骨折口内入路坚固内固定临床体会

目的：应用坚固内固定原理治疗双侧下颌骨骨折，并探索口内人路的手术方法。方法：18例患者均采用口内入路暴露下颌骨骨折部位（除升支及髁状突骨折），用钛钉作支抗复位下颌骨骨折，恢复其咬合关系后，用小型钛板作坚固内固定，术后不行颌问结扎。结果：18例伤口均一期愈合，全部病例咬合关系正常，无并发症。结论：双侧下颌骨骨折均采用口内入路，钛钉作支抗辅助复位，行坚固内固定，手术方便，易操作，术后不需颌间结扎。     

钛板钛钉坚固内固定技术在下颌骨骨折治疗中的应用

目的观察钛板钛钉坚固内固定技术在下颌骨骨折治疗中的效果。方法30例下颌骨不同部位骨折患者均采用切开复位钛板钛钉坚固内固定治疗,观察术后咬合关系恢复及骨折术后对位对线情况。结果全部患者均获得满意的治疗效果,术后复查X线片对位对线好,咬合关系恢复良好,无排异反应,无需颌间牵引,缩短了住院时间。结论钛板钛钉坚固内固定技术治疗下颌骨骨折效果好。     

虚拟手术计划在经口内入路行下颌骨切除及精确重建中的应用：附9例报道

目的 介绍在虚拟手术计划辅助下行经口内入路下颌骨切除和血管化骨重建的经验,评价术后重建效果。方法 对9例下颌骨良性肿瘤患者术前行虚拟手术计划,设计、制作适用于口内操作的预设钉孔的导板。然后经口内入路利用截骨导板行下颌骨切除,预弯钛板及血管化骨瓣的植入和固定。术中实时导航验证新下颌骨的空间位置。术后半年,通过临床及影像学检查评价患者外形和功能;通过术后CT与术前STL模型拟合,评估下颌骨重建的精确性。采用SPSS 15.0软件包对数据进行统计学分析。结果 在虚拟手术计划辅助下,9例患者均顺利完成经口内入路下颌骨切除及血管化下颌骨重建,术中导航证实重建下颌骨位置准确。术后半年复查见患者面部对称,无面瘫及开口受限。患者对手术效果满意。图像拟合显示,截骨线位置精确,误差<1 mm[（0.72±0.15）mm],下颌骨重建位置与术前设计高度一致,误差为（1.76±1.99）mm。结论 在虚拟手术计划辅助下,利用预设钉孔的导板和预弯钛板,可以精确实施口内下颌骨切除及血管化骨重建,避免了口外切口,显著提高了下颌骨重建的精确性。     

小型钛板用于腓骨重建下颌骨的临床疗效分析

目的 :评价小型钛板用于固定腓骨重建下颌骨的临床疗效。方法 :因口腔颌面部良恶性肿瘤需切除部分下颌骨的病例32例,选择血管化游离腓骨重建下颌骨,采用小型钛板进行内固定,术后对疗效进行评价。结果:29例患者创口一期愈合,2例发生感染而二期愈合,X射线复查骨愈合良好;1例因坏死、感染而二次手术取出腓骨瓣。大部分病例术后面部畸形不明显,咬合关系良好。结论:采用小型钛板固定腓骨重建下颌骨能获得较好的疗效。     

非血管化髂骨移植重建下颌骨缺损的临床分析

目的对非血管化髂骨移植重建下颌骨缺损的病例进行临床回顾性分析,探讨其治疗效果及手术注意事项。方法选择因肿瘤和外伤致下颌骨缺损后行自体非血管化髂骨同期移植重建术修复的34例患者为研究对象,分析其手术方法、术后效果及并发症的发生情况。结果采用游离非血管化髂骨同期移植重建下颌骨缺损的34例患者中,小钛板双排内固定31例,重建板内固定3例。34例患者中,成功病例27例（79.41%）,良好病例3例（8.82%）,失败病例4例（11.76%）。失败原因均为感染而取出植入骨。结论自体非血管化髂骨移植重建术是下颌骨缺损重建的重要方法之一,内固定的方式有小钛板和重建板。     

下颌骨单侧节段性缺损及重建对语音清晰度的影响

目的：通过语音清晰度测试，探讨下颌骨单侧节段性缺损及不同修复方法对语音功能的影响。方法：以32例下颌骨单侧节段性缺损手术患者为研究对象，应用汉语语音清晰度字表，对其手术前、后的语音功能进行测试，对结果进行Wilcoxon秩和检验。结果：患者手术前、后的语音清晰度（SI）无显著差异，短句测试效果满意。不同下颌骨单侧节段性缺损之间以及不同修复方法之间比较，SI改变无统计学意义。下颌骨单侧节段性缺损连续性中断组（8例）与连续性恢复组（24例）之间，SI改变无统计学意义。结论：下颌骨单侧节段性缺损对患者的语音清晰度并无显著影响；不同重建方法（拉拢缝合、钛板重建、钛板＋骨瓣修复等）对患者语音清晰度的影响无统计学意义；语音清晰度测试可能无法精确反映下颌骨单侧节段性缺损患者的语音功能改变。     

下颌骨缺损重建术后钛板相关并发症97例临床回顾研究

目的 分析下颌骨节段性缺损患者的重建修复术后钛板相关并发症及其影响因素.方法 回顾性分析660例病例中导致颌骨缺损的原因主要有鳞状细胞癌205例(31.1％)、成釉细胞瘤198例(30.0％);下颌骨缺损类型以不包括髁突缺损的一侧下颌骨不超过中线的任何长度缺损为主,共324例(49.1％).按照修复方式分为骨移植修复组(600例)和非骨移植修复组即重建钛板桥接修复组(60例).分析660例下颌骨节段性缺损患者颌骨缺损的病因、缺损类型、术后钛板相关并发症及其影响因素.结果 整体术后钛板相关并发症的发生率为14.7％ (97/660),其中钛钉松动5.8％ (38/660)、钛板折断3.3％(22/660)、钛板外露3.8％(25/660)、术后感染7.4％(49/660)、骨愈合不良或不愈合2.9％(19/660).骨移植修复组并发症发生率11.0％(66/600)显著低于重建钛板桥接修复组51.7％ (31/60).骨移植+小型钛板修复组术后并发症发生率为10.8％(63/586).腓骨+小型钛板修复组术后钛钉松动位置集中在髁突-腓骨连接处、下颌角-腓骨连接处以及下颌角两腓骨连接处.放疗、糖尿病史与术后并发症有关,钛板外露与放疗关系显著(P值=0.000).结论 骨移植重建下颌骨可以有效减少术后并发症;放疗、糖尿病史与术后并发症有关.     

骨内颌间牵引钛钉在复杂下颌骨骨折中的应用

目的:评价骨内颌间牵引钛钉在复杂下颌骨骨折中应用的临床效果.方法:对50例复杂下颌骨骨折患者先应用骨内颌间牵引钛钉进行颌间固定,再行切开复位内固定术,术后行骨内颌间牵引2～4周.结果:50例复杂下颌骨骨折均获得良好的复位和骨性愈合,咬合关系良好,无明显并发症.结论:骨内颌间牵引钛钉能缩短手术复位操作时间,对下颌骨的整复固定和功能恢复效果良好.     

Stability of bioresorbable plates following reduction of mandibular body fracture: Three-dimensional analysis

PurposeThe recent development of bioresorbable bone plates and screws allows plates to be applied to the load-bearing regions of the mandible and to remain in place over time without the need for removal. We hypothesized that the stability of composite plates and screws forged from unsintered hydroxyapatite particles and poly-l-lactide (u-HA/PLLA) is comparable to that of standard titanium fixation systems for the reduction of fractures of load-bearing regions of the mandibular body.Materials and methods40 patients underwent open reduction and internal fixation of the fractured mandibular body with either a titanium or u-HA/PLLA bone plate. Cone-beam CT images were obtained immediately postoperatively and at 6-month follow-up, and were analyzed for positional changes of the affected mandible.ResultsThere were no significant differences in the postoperative positional changes of reference points between the titanium and u-HA/PLLA miniplates, except for that for the coronoid process (p-value = 0.03). Multivariate regression analysis revealed no significant differences in spatial changes between the immediate postoperative and 6-month follow-up images, after adjusting for age and sex.ConclusionThe stability of bioresorbable u-HA/PLLA miniplates and screws was comparable to that of titanium miniplates and screws immediately postoperatively and at 6-month follow-up, following surgical reduction of fractures of load-bearing regions of the mandibular body. Bioresorbable osteosynthesis can be considered a viable alternative to titanium osteosynthesis.     

生长期山羊囊内骨折复位术中保留髁突软骨的重要性及组织学研究

目的：通过组织学观察,探讨髁突囊内骨折内固定术中保留和切除髁突软骨对髁突生长发育的影响。方法：6个月龄山羊12只,随机分为实验组（n=8）和对照组（n=4）。实验组双侧髁突造成囊内骨折并同期行手术复位固定．一侧保留髁突软骨,另一侧切除髁突软骨。术后3个月、6个月处死动物,切取髁突标本行石蜡切片和硬组织切片观察骨折愈合和髁突生长情况。结果：实验组髁突骨折愈合良好,钛板被新生骨组织覆盖;HE染色显示．保留髁突软骨组,髁突软骨结构清晰,与正常对照髁突相同,软骨成骨活跃,髁突生长发育正常;切除髁突软骨组,髁突软骨层消失,表面为成熟的骨细胞覆盖,直接与关节盘的纤维组织相连,新生骨组织少见：硬组织切片显示,钛板与骨组织直接结合．未见组织渗出和排异反应。结论：手术复位髁突囊内骨折时保留髁突软骨,不会影响髁突的生长发育;损伤髁突软骨．会造成髁突与关节盘黏连．引起髁突生长发育障碍。     

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。     

Mandibular Fracture in Conjunction with Bicortical Penetration,Using Wide‐Diameter Endosseous Dental Implants

Prosthodontic rehabilitation of a patient with an atrophic edentulous mandible presents a significant challenge in restoring esthetics and function. The purpose of this clinical report is to describe fracture of an atrophic edentulous mandible opposing maxillary natural dentition in association with endosseous dental implants. The patient received two wide‐diameter implants in the anterior mandible for an implant‐assisted mandibular overdenture, in which the implants penetrated the inferior border of the mandible for bicortical stabilization. Three months following implant placement surgery, the patient experienced pain, swelling, and intraoral purulent drainage around the right implant. Panoramic radiograph revealed a fracture of the mandible through the right implant site and signs of infection around the left implant. The implants were removed surgically, and open reduction and fixation of the fracture site were undertaken using a titanium bone fixation plate. This clinical report demonstrates that placement of wide‐diameter implants in conjunction with bicortical penetration in a severely atrophic edentulous mandible can risk fracture of the mandible.     

数字化技术结合导板在下颌骨粉碎性骨折复位内固定术中的应用

目的 探讨数字化技术、3D打印模型结合导板在下颌骨粉碎性骨折中的应用。方法 选取下颌骨粉碎性骨折患者19例,进行1.0 mm层厚三维CT扫描,数据通过DICOM格式导出,利用软件进行虚拟手术复位骨折,复位后3D打印出下颌骨模型及咬合导板。在下颌骨模型上进行钛板预弯及制作复位导板,术中引导骨折块复位固定。结果 术后19例患者手术切口均无感染征,创口隐蔽美观,骨折对位精确,钛板与骨折段贴合;术后6月随访骨折对位愈合情况好,无明显移位。患者下颌无偏斜,无张口、咬合疼痛,咬颌关系良好,未见明显张口受限。结论 数字化技术、3D打印模型结合导板能让下颌骨粉碎性骨折精确复位,简化手术过程,是一种精准、可预测的手术辅助方式。     

Inferior alveolar nerve repositioning

Nerve repositioning is a viable alternative for patients with an atrophic edentulous posterior mandible. Patients, however, should be informed of the potential risks of neurosensory disturbance. Documentation of the patient's baseline neurosensory function should be performed with a two-point discrimination test or directional brush stroke test preoperatively and postoperatively. Recovery of nerve function should be expected in 3 to 6 months. The potential for mandibular fracture when combining nerve repositioning with implant placement also should be discussed with the patient. This can be avoided by minimizing the amount of buccal cortical plate removal during localization of the nerve and maintaining the integrity of the inferior cortex of the mandible. Additionally, avoid overseating the implant, thus avoiding stress along the inferior border of the mandible. The procedure does allow for the placement of longer implants, which should improve implant longevity. Patients undergoing this procedure have expressed overall satisfaction with the results. Nerve repositioning also can be used to preserve the inferior alveolar nerve during resection of benign tumors or cysts of the mandible. This procedure allows the surgeon to maintain nerve function in situations in which the nerve would otherwise have to be resected.     

Comparison of outcome of open reduction and internal fixation versus closed treatment in pediatric mandible fractures-a retrospective study

The aim of the study was to compare the outcome and complications of open reduction and internal fixation (ORIF) with closed treatment, as well as to review the literature. This was a retrospective study on pediatric patients with mandible fracture. The primary objective was a comparison of outcomes in terms of bone healing, maximal incisal opening (MIO), and occlusion, and the secondary objective was to review complications. A total of 77 pediatric patients (age <12 years) were managed with closed treatment and 23 with ORIF. In all, 62 patients were found with a single fracture (22 patients with parasymphysis fracture and 21 with condyle fracture, followed by symphysis, angle, and body fracture) and 38 patients with more than one fracture, with symphysis and bilateral condyle fracture being the most common. Bone healing was observed in all the patients. Mean MIO was 26.9 ± 2.8 mm and 29.3 ± 1.7 mm in the closed and ORIF group, respectively, and the difference was statistically nonsignificant (p = 0.5). One patient (1.3%) had deranged occlusion, and mobility was observed in one patient (1.3%) in the closed treatment group. Infection and nerve paresthesia were not seen in any patient at follow-up. Although closed treatment is preferred, as it preserves the soft tissue and periosteum, a displaced mandible fracture especially with co-existing condylar fracture should be treated by ORIF.     

兔下颌骨骨折三维有限元模型的建立

目的：建立兔下颌骨垂直及斜行骨折的三维有限元模型，为开展生物力学试验仿真提供平台。方法：采用雄性新西兰大白兔为标本，将用CT所获得的下颌骨DICOM数据通过CAD软件直接建立三维模型，并设计接骨板三维模型：将接骨板和下颌骨的三维模型进行装配，最终在FEA软件中设计骨折线的方向和间隙大小，并划分网格。结果：建立了包括骨折线方向、接骨板、骨折间隙大小等信息在内的兔下颌骨骨折的三维有限元模型。结论：建立了具有高度几何相似性的兔下颌骨骨折模型，为骨折愈合的生物力学研究奠定了基础；所采用的DICOM数据直接建模法，具有准确高效的特点。     

下颌骨髁突不同类型骨折钛板内固定手术治疗相关影响因素分析

目的：分析下颌骨髁突不同类型骨折进行钛板内固定手术及其影响术后并发症的相关因素,为以后下颌骨髁突骨折治疗总结经验以便更好的为患者服务。方法：收集温州医科大学附属口腔医院2003年4月~2012年4月手术完成的下颌骨髁突骨折行钛板内固定患者,手术前后复查对比下颌骨全景片、下颌骨平扫CT、下颌骨矢状CT及颅颌三维CT重建。依据下颌骨骨折部位分为髁突囊内骨折,髁突颈部骨折,髁突基部骨折3组,对3组骨折术后患者的咬合状况、开口度、面神经功能等恢复情况进行回顾性分析。结果：210例随访病例中,术后咬合关系恢复不良30例;螺钉松动57枚,钛板断裂0例,面神经颧支损伤15例,面神经颞支损伤30例,张口受限伴下颌运动曲线患侧偏斜35例。结论：解剖手术能力或者面神经的个体变异;创口感染;不适当的应力集中、钛板和螺钉的位置、数量及固定部位,颌间牵引,关节周围相关软组织复位状况等为影响下颌骨髁突骨折坚强内固定手术并发症相关因素。     

双板坚固内固定在髁突骨折手术中的应用及效果评价

目的 探讨双板坚固内固定在下颌骨髁突骨折手术中的应用及效果评价。方法 对28例下颌骨髁突骨折患者行2块钛板坚固内固定术,术后随访拍摄全景片或三维CT,对患者的咬合关系、张口度、张口型、钛板及骨折情况等进行评价。结果 28例患者术后骨折固位良好;咬合关系、张口度、张口型恢复正常;无1例出现钛板变形或断裂、骨折移位;2例出现面神经轻度瘫痪,予以神经营养药物治疗后,3月内恢复正常;2例术后1月出现颞颌关节弹响,取出钛板后好转。结论 双板坚固内固定治疗下颌骨髁突骨折是一种较为理想的方法。