血管化骨移植修复颌骨严重缺损并种植义齿修复

目的:颌骨外伤、肿瘤或其他疾病常导致上下颌骨严重缺损,此时如何重建口腔颌面部的形态和功能一直是口腔修复的难点和挑战。本研究旨在观察血管化骨移植修复颌骨缺损并种植义齿修复的临床效果。方法:对12例颌骨严重缺损患者行血管化髂骨肌瓣或血管化腓骨肌皮瓣修复骨缺损,对牙列缺损患者采用手术导板指导移植骨块的定位,7例患者在导板指导下行同期牙种植体植入术。5例患者在术后4～6月行延期牙种植体植入术。3～4月后行种植义齿修复,其中种植覆盖义齿4例,种植固定义齿8例。结果:所有病例的血管化自体骨移植均获成功。种植义齿修复后经3～24月的临床观察,X片显示种植体与移植骨间未见透射影,2例发生种植体周围软组织增生,患者对形态和功能恢复感到满意。结论:血管化骨移植并种植义齿修复用于颌骨严重缺损的功能重建可获得良好的临床效果,其远期疗效有待进一步观察。

Vascularized bone graft for reconstruction of jaws with serious defects and dental implant rehabilitation

Objective： Jaw trauma,tumor or other diseases often lead to serious defects in the upper and lower jaw,then how to reconstruct oral and maxillofacial contour and function has been the difficulty and challenges for oral rehabilitation.This study aimed to investigate the clinical effect of vascularized bone graft for jaw reconstruction and dental implant restorations.Methods： 12 cases of jaw serious defects were repaired with the free osseous myocutaneous flap of ilium or fibula.The surgery templates were used to position the graft bone for patients with dentition defects.7 patients combined with immediate implants insertion under the surgery guide.5 patients performed delayed implants insertion after 4 to 6 months.The superstructure restorations were placed 3 to 4 months later,of which 4 cases re ceived the implant overdentures,the other 8 cases with implant fixed dentures.Results： All cases of vascularized autogenous bone grafts were successful.During 3 to 24 months clinical observation after the implant restoration,X rays indicated no radiolucencies between the grafting bone and the implants,2 cases occurred peri-implant soft tissue proliferation,patients reported being satisfied with the contour and functional recovery.Conclusions： The vascularized bone graft combined with implant denture restoration for the jaw severe defects in functional reconstruction obtained good clinical results,the long-term effect needs further observation.