预成型钛重建板联合血管化髂骨肌瓣在下颌骨修复重建的应用研究
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摘要
目的:研究预成型钛重建板联合血管化髂骨肌瓣在下颌骨修复重建的应用效果。方法:前瞻性选取50例下颌骨肿瘤患者,采用抽签法随机将其分为观察组和对照组,每组25例。观察组患者采用预成型钛重建板联合血管化髂骨肌瓣进行下颌骨精确重建,对照组患者采用虚拟手术辅助血管化髂骨肌瓣进行下颌骨重建,比较两组患者的手术疗效和不良反应的发生。结果:观察组手术疗效优良24例(占96%),明显高于对照组的20例(占80%),差异具有统计学意义(x~2=10.951,P<0.05);观察组不良反应发生5例(占20%),对照组为13例(占52%),观察组明显较对照组低,差异有统计学意义(x~2=10.624,P<0.05)。结论:预成型钛重建板联合血管化髂骨肌瓣技术治疗下颌骨损伤患者的疗效较好,术后不良反应较少。
Objective: To investigate the application effect of prefabricated reconstructive titanic plate combined with vascularized iliac bone-muscular flap in repairing and remodeling mandibular defects. Methods: This study is a prospective study, and 50 patients with mandibular tumor were enrolled in the research. And all of them were divided into observation group(25 cases) and control group(25 cases). The patients of observation group were implemented precise remodeling of mandible by using prefabricated reconstructive titanic plate combined with vascularized iliac bonemuscular flap, and that of control group were implemented remodeling of mandible by using virtual surgery assisted to vascularized iliac bone-muscular flap. And the occurrences of surgical effect and adverse reaction between the two groups were compared and analyzed. Results: The surgical effect of observation group(24 cases, 96%) was significantly higher than that of control group(20 cases, 80%)(x~2=10.951, P<0.05). And the adverse reaction rate of observation group(5 cases, 20%) was significantly lower than that of control group(13 cases, 52%)(x~2=10.624, P<0.05). Conclusion: Prefabricated reconstructive titanic plate combined with vascularized iliac bone-muscular flap can obtain better effect in repairing and reconstructing mandibular defects, and its postoperative adverse reactions are less.
Objective: To investigate the application effect of prefabricated reconstructive titanic plate combined with vascularized iliac bone-muscular flap in repairing and remodeling mandibular defects. Methods: This study is a prospective study, and 50 patients with mandibular tumor were enrolled in the research. And all of them were divided into observation group(25 cases) and control group(25 cases). The patients of observation group were implemented precise remodeling of mandible by using prefabricated reconstructive titanic plate combined with vascularized iliac bonemuscular flap, and that of control group were implemented remodeling of mandible by using virtual surgery assisted to vascularized iliac bone-muscular flap. And the occurrences of surgical effect and adverse reaction between the two groups were compared and analyzed. Results: The surgical effect of observation group(24 cases, 96%) was significantly higher than that of control group(20 cases, 80%)(x~2=10.951, P<0.05). And the adverse reaction rate of observation group(5 cases, 20%) was significantly lower than that of control group(13 cases, 52%)(x~2=10.624, P<0.05). Conclusion: Prefabricated reconstructive titanic plate combined with vascularized iliac bone-muscular flap can obtain better effect in repairing and reconstructing mandibular defects, and its postoperative adverse reactions are less.
引文
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[14]刘林,夏德林,孙黎波,等.个性化预成型重建板技术联合血管化髂骨肌瓣在下颌骨修复重建中的应用[J].中华整形外科杂志,2016,32(4):258-263.
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[16]Cuesta Gil M,Bucci T,Ruiz BD,et al.Implant mandibular rehabilitation postoncologic segmental resection:a clinical report[J].Implant Dent,2012,21(2):104-107.
[17]Smolka K,Kraehenbuehl M,Eggensperger N,et al.Fibula free flap reconstruction of the mandible in cancer patients:Evaluation of a combined surgical and prosthodontic treatment concept[J].Oral Oncology,2008,44(6):571-581.
[2]Kakabadze A,Mardaleishvili K,Loladze G,et al.Reconstruction of mandibular defects with autogenous bone and decellularized bovine bone grafts with freeze-dried bone marrow stem cell paracrine factors[J].Oncol Lett,2017,13(3):1811-1818.
[3]桑炜荣,刘雁鸣,严奉国.血管化游离髂骨瓣在下颌骨缺损中的临床应用[J].浙江创伤外科,2016,21(3):451-453.
[4]Zhang WB,Yu Y,Wang Y,et al.Improving the accuracy of mandibular reconstruction with vascularized iliac crest flap:Role of computerassisted techniques[J].J Craniomaxillofac Surg,2016,44(11):1-13.
[5]宁尚波,付爽.个性化预成型重建板技术联合血管化髂骨肌瓣对下颌骨修复重建的应用[J].黑龙江医药科学,2017,40(4):156-157.
[6]L?fstrand J,Nyberg M,Karlsson T,et al.Quality of Life after Free Fibula Flap Reconstruction of Segmental Mandibular Defects[J].J Reconstr Microsurg,2018,34(2):108-120,
[7]Hu F,Gu Y,Zhang X,et al.Combined use of a gasket seal closure and a vascularized pedicle nasoseptal flap multilayered reconstruction technique for high-flow cerebrospinal fluid leaks after endonasal endoscopic skull base surgery[J].World Neurosurg,2015,83(2):181-187.
[8]李军,沈毅,孙坚.虚拟手术辅助的血管化髂骨肌瓣行下颌骨精确重建[J].实用肿瘤杂志,2015,30(1):12-17.
[9]任黎蕾,徐荣盛,先德彬,等.两种血管化骨移植在下颌骨节段性缺损重建中的选择[J].泸州医学院学报,2016,39(5):455-460.
[10]Ma J,Ma L,Wang Z,et al.The use of 3D-printed titanium mesh tray in treating complex comminuted mandibular fractures[J].Medicine,2017,96(27):e7250.
[11]Shen SY,Yu Y,Zhang WB,et al.Angle-toAngle mandibular defect reconstruction with fibula flap by using a mandibular fixation device and surgical navigation[J].J Craniofac Surg,2017,28(6):1486-1491.
[12]Zhou M,Peng X,Mao C,et al.The Value of SPECT/CT in Monitoring Prefabricated TissueEngineered Bone and Orthotopic rh BMP-2 Implants for Mandibular Reconstruction[J].Plos One,2015,10(9):e0137167.
[13]桑炜荣,刘雁鸣,严奉国.基于三维CT重建的快速成型技术在下颌骨重建的临床应用[J].口腔医学,2015,35(9):776-779.
[14]刘林,夏德林,孙黎波,等.个性化预成型重建板技术联合血管化髂骨肌瓣在下颌骨修复重建中的应用[J].中华整形外科杂志,2016,32(4):258-263.
[15]鲍光辉,付跃进,张卫健.钛板内固定治疗下颌骨骨折的临床疗效观察[J].中国当代医药,2010,17(19):41-42.
[16]Cuesta Gil M,Bucci T,Ruiz BD,et al.Implant mandibular rehabilitation postoncologic segmental resection:a clinical report[J].Implant Dent,2012,21(2):104-107.
[17]Smolka K,Kraehenbuehl M,Eggensperger N,et al.Fibula free flap reconstruction of the mandible in cancer patients:Evaluation of a combined surgical and prosthodontic treatment concept[J].Oral Oncology,2008,44(6):571-581.