种植联合血管化髂骨移植重建14例下颌骨缺损的长期疗效观察

目的: 通过临床及影像学方法,评估种植联合血管化髂骨移植重建下颌骨缺损的长期疗效。方法: 对上海交通大学医学院附属第九人民医院1995—2005年收治的14例患者47颗植入血管化髂骨的种植体进行随访,其中10例30颗种植体为下颌骨血管化髂骨重建术中同期植入,4例17颗种植体为术后二期植入,上部结构均采用种植支持式固定义齿修复。评估分析种植体15年累积生存率及修复体生存率,修复完成后5年及10年分别进行临床评价。采用SPSS 26.0软件包对数据进行统计学分析。结果: 种植体均未发生愈合期内失败。种植体10年、15年累积生存率分别为90.44%和86.67%,修复体15年累积生存率为78.32%。种植体5年及10年边缘骨吸收分别为（2.08±0.27）mm和（4.22±0.48）mm,两者有显著差异（P<0.0001）。生物学并发症主要为种植体周围炎及软组织增生,机械并发症主要为修复体磨耗。结论: 种植联合血管化髂骨移植重建下颌骨缺损的长期疗效较为稳定,是下颌骨缺损重建的有效方法;但种植体周围炎发生率较高,维护种植体周围软、硬组织的稳定是种植体远期疗效的重要保证。

Long-term performance of dental implants in vascularized iliac crest grafts for mandibular reconstruction in 14 consecutive patients

PURPOSE: To evaluate the long-term performance of dental implants installed in vascularized iliac crest grafts for mandibular reconstruction by clinical and radiographic examinations. METHODS: From 1995 to 2005, 47 implants installed in vascularized iliac crest grafts for mandibular reconstruction in 14 patients were analyzed, including 30 implants immediately placed into vascularized iliac crest grafts in 10 patients and 17 implants placed later in 4 patients. The cumulative survival rate within 15 years of dental implants and prostheses was evaluated. Clinical assessments and radiographic examination were performed 5 years and 10 years after implant loading. Statistical analysis was performed using SPSS 26.0 software package. RESULTS: No early failures occurred during the healing period. Cumulative survival rates of implants for 10 years and 15 years were 90.44% and 86.67% and cumulative survival rate of prostheses for 15 years was 78.32%, respectively. The average marginal bone loss at 5 years was (2.08±0.27) mm, while that at 10 years was (4.22±0.48) mm (P<0.0001). Biological complications were peri-implantitis and soft tissue hyperplasia, and mechanical complication was abrasion of the prostheses mainly. CONCLUSIONS: The long-term performance of dental implants installed in vascularized iliac crest grafts for mandibular reconstruction is stable, which is an effective method for mandibular defect reconstruction, but the incidence of peri-implantitis is relatively higher. So, maintaining the stability of soft and hard tissues around the implant is a crucial guarantee for the long-term performance of implants.