非血管化髂骨与血管化髂骨移植同期种植重建下颌骨节段缺损对比研究

目的 探讨非血管化髂骨与血管化髂骨移植同期种植重建下颌骨节段缺损的临床效果.方法 选取30例下颌骨节段缺损患者为研究对象,根据随机数字表分为血管化髂骨移植同期修复组（血管化组）15例以及非血管化髂骨移植同期修复组（非血管化组）15例,对比分析两组临床治疗效果、手术情况、术后并发症发生率,并于术后1、2、4个月应用显微CT观察患者骨质骨形态结构的变化.结果 非血管化组术中出血量、手术时间、术后住院时间均少于血管化组,差异有统计学意义（P〈0.05）.血管化组Ⅰ期愈合率为53.33%、Ⅱ期愈合率为40.00%,非血管化组Ⅰ期愈合率为46.67%、Ⅱ期愈合率为40.00%,两组愈合率无统计学意义（P〉0.05）.非血管化组术后总并发症发生率高于血管化组,差异有统计学意义（P〈0.05）,非血管化组术后植骨吸收率较高,差异有统计学意义（P〈0.05）.血管化组术后1个月、2个月TV/BV、Tb.Th、Tb.Sp、Tb.N等指标优于非血管化组（P〈0.05）,而术后4个月,非血管化TV/BV、Tb.Th、Tb.Sp、Tb.N等指标与血管化组相比无统计学意义（P＞0.05）.结论 非血管化髂骨移植同期修复下颌骨缺损对患者的创伤少、修复效果理想、操作简单易行,具有较高的临床应用价值.但患者术后容易发生感染及移植骨吸收,需掌握好手术适应证.

A comparative study of non-vascularized iliac bone and vascularized iliac bone graft reconstruction of segmental mandibular planted earlier defects

Objective To investigate the clinical effects of non-vascularized iliac bone and vascularized iliac bone graft reconstruction of seglnental mandibular silnuhaneous implantation defects. Methods 30 cases of seglnental mandibular defect in patients were selected with the randoln nulnber table. All patients were assigned into 15 cases of vascularized iliac bone graft repair group over the salne period （revascularization group） and 15 cases of non-vascularized iliac bone graft repair group over the same period （non-vascularized group）. The clinical treatment, surgery, postoperative complication rate and bone absorption of two groups were compared. Results The blood loss （ 189.6 ± 45.3 vs 278.6 ± 78.6 ） lnL, operative tilne （ 145.6 ± 31.8 vs 242.6 ± 42.3）mm, postoperative hospital stay （7.9± 1.8 vs 11.5± 2.9） were less than those in revascularization group （P 〈 0.05）. The rates of healing I and healing II were 53.33% and 40.00% of vascularized healing group while those in non-vascularized healing group were 46.67% and 40.00%. The differences were statistically significant （P 〉 0.05）. The rate of postoperative complications of non-vascularized group was higher than that in vascularized group,with statistically significant difference （P 〈 0.05）. The rate of absorption of non-vascularized bone graft group was higher than that in revascularization group（P 〈0.05 ）. in revascularization group after one lnonth,two lnonths TV / BV,Tb. Th,Tb. Sp,Tb. N indicators were better than those of non-vascularized group （P 〈 0.05） ,but after four lnonths,there were no statistically significant differences （P 〉 0.05）. Conclusions Non-vascularized iliac bone graft mandibular reconstruction is satisfactory repair with less traulna and, silnple operation,which has a high clinical value. However, patients are prone to infection and transplantation of bone resorption,therefore,it is necessary to lnaster surgical indications.