腓骨肌(皮)瓣平行折叠结合人工关节重建下颌骨缺损

目的:采用腓骨肌(皮)瓣平行折叠技术改善单段腓骨重建下颌骨所致的高度不足,并结合人工关节重建下颌骨大型缺损。方法:对13例下颌骨大型节段性缺损患者,采用腓骨肌(皮)瓣平行折叠技术重建。术前均采用CAD/CAM技术制作个体化头模、设计腓骨修复的位置及高度。根据缺损部位,分别采用下颌体平行折叠或部分平行折叠,对缺损累及下颌体、下颌支及髁突者,则结合人工关节一并修复。结果:移植腓骨肌(皮)瓣全部成活,下肢供区无并发症。面部外形满意,开口度2.5～3.5cm,重建下颌骨的高度低于健侧,在-0.3～1.5cm之间,平均0.47cm,种植义齿与余留牙咬合关系正常、发音清晰。复查全景片及三维CT,显示腓骨骨段的位置和高度与术前设计一致,髁突或人工关节位于关节窝内。结论:腓骨肌(皮)瓣平行折叠技术及结合人工关节为重建半侧下颌骨大型缺损,以及增加其高度提供了一种较为简单可行、效果良好的修复手段。建议在主要承担咀嚼功能的颏部和体部行平行折叠植骨,在非承担咀嚼功能的下颌支,则使用人工材料。

Reconstruction of mandibular defect with double barrel fibular osteocutaneous graft and condylar prosthesis

PURPOSE:To improve the height deficiency resulted from the conventional straight fibular graft,double barrel fibular osteocutaneous graft(DBFOG) and condylar prostheses were used to reconstruct large mandibular defects.METHODS:13 patients underwent reconstruction of large segmental mandibular defects with DBFOG techniques.The reconstructed sites and heights of the fibula were designed on individual models of the mandible which were made preoperatively by CAD/CAM techniques in all patients.DBFOG in the mandibular body or partial DBFOG were performed in different patients according to the location of the defect.DBFOG and condylar prosthesis were used when the defect involved mandibular body,ramus and condylar process.RESULTS:The fibular osteocutaneous grafts in all patients survived without complications in the donor site of the lower extremities.The contours of the face were satisfied and mouth opening ranged from 2.5cm to 3.5cm.The average height of the reconstructed mandibles was lower than that of the normal sides by 0.47cm,ranging from-0.3cm to 1.5 cm.Occlusions were normal and speeches were comprehensible.Panoramic radiograph and the three-dimensional CT scan revealed that the locations and heights of the fibular bones reach as the pre-operative design.The condylar prostheses were located within the glenoid fossa.CONCLUSION:DBFOG might provide a relatively simple and effective technique for reconstructing large mandibular defects and augmenting the height of the mandible.We suggested that DBFOG be used for reconstruction of defects in mandibular body and mental regions where bear major mastication forces,and artificial prostheses be applied for reconstruction of the ramus where bears no-mastication forces.