口内入路切除下颌骨良性肿瘤游离髂骨移植重建术后髁突位置及骨高度动态变化的临床研究
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摘要
目的
探讨口内入路切除下颌骨良性肿瘤游离髂骨移植重建术后髁突位置及骨高度的动态变化。
方法
收集2006年6月-2010年4月因下颌骨良性肿瘤收入湘雅二医院口腔颌面外科病房住院手术的患者共20例,手术方式均为口内入路切除下颌骨良性肿瘤游离髂骨移植重建,按照是否保留髁突分为A、B两组,按照游离髂骨是否分段移植分为C、D两组,收集患者术前,术后一周-12个月的曲面体层片,通过对患者术后各个时间点曲面体层片中游离骨的骨高度及颞下颌关节间隙的测量(张震康法和Kamelchuk法),研究其髁突位置及骨高度的动态变化。
结果
1、A组患侧和健侧术前与术后的关节前、上、后间隙的差异均无统计学意义(p＞0.05),关节间隙线性百分比的差异均无统计学意义(p>0.05),A组患侧和健侧术后髁突位置居中。
2、B组患侧术前与术后的关节前、后间隙的差异有统计学意义(p<0.05),B组患侧术前与术后的关节间隙线性百分比的差异有统计学意义(p＜0.05),B组患侧术后髁突位置前移。
3、A组在术后3个月、术后6个月、术后12个月升支游离骼骨骨高度的吸收率分别为1.8%,3.2%和4.3%,升支游离髂骨骨高度有较小程度的降低。
4、B组在术后3个月、术后6个月、术后12个月升支游离髂骨骨高度的吸收率分别为7.9%,19.8%和34.7%,升支游离髂骨骨高度降低的幅度较大。
5、C组与D组在0-3月,0-6月和0-12月三个位点的平均吸收率差别不大,D组比C组略高0.8%-4.7%,D组的B点和B’点的吸收率明显高于C组,达到4%-16.5%。
结论
1、保留髁突的游离髂骨移植,其患侧和健侧髁突位置均无明显改变；未保留髁突的游离髂骨移植,健侧髁突位置前移。
2、游离髂骨分段移植与整块移植相比,其两块移植骨相接处吸收率较高。
3、保留髁突的游离髂骨移植能够保持升支移植骨高度。
4、口内入路与口外入路的游离髂骨移植,其移植骨吸收率无明显差别。
Objective
To investigate the change of the position of condylar process and the height of bone grafts in benign mandibular tumor resection with intra-oral route and immediate reconstruction by non-vascularized iliac bone grafts.
Methods
In this article,20 patients admitted to the Department of Oral and Maxillofacial Surgery, Second Xiangya Hospital of Central South University for benign mandibular tumor were followed from June 2006 to April 2010. All of them were treated with benign mandibular tumor resection via intra-oral route and immediate reconstruction by non-vascularized iliac bone grafts. We divided them into groups according to the preservation of condylar process and the blocks of free autogenous iliac bone. We measured the height of free autogenous iliac bone and the joint space by panoramic radiographs to discuss the the change of the position of condylar process and the height of free autogenous iliac bone in benign mandibular tumor resection with intra-oral route and immediate reconstruction by non-vascularized iliac bone grafts.
Results
1. The linear distances of TMJ space showed no significant differences (p>0.05), and it was not statistically significant (p>0.05) on the ration between anterior TMJ and posterior TMJ linear distances before and after operation in group A.
2. It was statistically significant (p<0.05) on the linear distances of TMJ space, and the ration between anterior TMJ and posterior TMJ linear distances showed significant differences (p<0.05) before and after operation in group B.
3. The absorption rate of bone grafts of ramus 3 months,6months and 12 months after operation was 1.8%,3.2% and 4.3% in group A.
4. There was obvious reduction in group B. The absorption rate of bone grafts of ramus 3 months,6months and 12 months after operation was 7.9%,19.8% and 34.7%.
5. The average absorption rate of the bone grafts showed no significant difference between group C and group D 3 months,6months and 12 months after operation. The rate was 0.8%-4.7% more in group D. The B and B'spot of bone grafts were absorbed much heavier in group D, and the rate was 4%-16.5% more than in group C.
Conclusion
1. The position of condylar process showed no change in the condyles reserved cases, while the condylar process of the normal side moved forward in the condyles removed cases after operation.
2. Comparing with one bone graft, the absorption rate was higher in the position of two bone grafts contacted。
3. The preservation of condylar process can keep the height the bone grafts.
4. The average absorption rate of the bone grafts showed no significant differences between the operation with intra-oral route and the outside route.
探讨口内入路切除下颌骨良性肿瘤游离髂骨移植重建术后髁突位置及骨高度的动态变化。
方法
收集2006年6月-2010年4月因下颌骨良性肿瘤收入湘雅二医院口腔颌面外科病房住院手术的患者共20例,手术方式均为口内入路切除下颌骨良性肿瘤游离髂骨移植重建,按照是否保留髁突分为A、B两组,按照游离髂骨是否分段移植分为C、D两组,收集患者术前,术后一周-12个月的曲面体层片,通过对患者术后各个时间点曲面体层片中游离骨的骨高度及颞下颌关节间隙的测量(张震康法和Kamelchuk法),研究其髁突位置及骨高度的动态变化。
结果
1、A组患侧和健侧术前与术后的关节前、上、后间隙的差异均无统计学意义(p＞0.05),关节间隙线性百分比的差异均无统计学意义(p>0.05),A组患侧和健侧术后髁突位置居中。
2、B组患侧术前与术后的关节前、后间隙的差异有统计学意义(p<0.05),B组患侧术前与术后的关节间隙线性百分比的差异有统计学意义(p＜0.05),B组患侧术后髁突位置前移。
3、A组在术后3个月、术后6个月、术后12个月升支游离骼骨骨高度的吸收率分别为1.8%,3.2%和4.3%,升支游离髂骨骨高度有较小程度的降低。
4、B组在术后3个月、术后6个月、术后12个月升支游离髂骨骨高度的吸收率分别为7.9%,19.8%和34.7%,升支游离髂骨骨高度降低的幅度较大。
5、C组与D组在0-3月,0-6月和0-12月三个位点的平均吸收率差别不大,D组比C组略高0.8%-4.7%,D组的B点和B’点的吸收率明显高于C组,达到4%-16.5%。
结论
1、保留髁突的游离髂骨移植,其患侧和健侧髁突位置均无明显改变；未保留髁突的游离髂骨移植,健侧髁突位置前移。
2、游离髂骨分段移植与整块移植相比,其两块移植骨相接处吸收率较高。
3、保留髁突的游离髂骨移植能够保持升支移植骨高度。
4、口内入路与口外入路的游离髂骨移植,其移植骨吸收率无明显差别。
Objective
To investigate the change of the position of condylar process and the height of bone grafts in benign mandibular tumor resection with intra-oral route and immediate reconstruction by non-vascularized iliac bone grafts.
Methods
In this article,20 patients admitted to the Department of Oral and Maxillofacial Surgery, Second Xiangya Hospital of Central South University for benign mandibular tumor were followed from June 2006 to April 2010. All of them were treated with benign mandibular tumor resection via intra-oral route and immediate reconstruction by non-vascularized iliac bone grafts. We divided them into groups according to the preservation of condylar process and the blocks of free autogenous iliac bone. We measured the height of free autogenous iliac bone and the joint space by panoramic radiographs to discuss the the change of the position of condylar process and the height of free autogenous iliac bone in benign mandibular tumor resection with intra-oral route and immediate reconstruction by non-vascularized iliac bone grafts.
Results
1. The linear distances of TMJ space showed no significant differences (p>0.05), and it was not statistically significant (p>0.05) on the ration between anterior TMJ and posterior TMJ linear distances before and after operation in group A.
2. It was statistically significant (p<0.05) on the linear distances of TMJ space, and the ration between anterior TMJ and posterior TMJ linear distances showed significant differences (p<0.05) before and after operation in group B.
3. The absorption rate of bone grafts of ramus 3 months,6months and 12 months after operation was 1.8%,3.2% and 4.3% in group A.
4. There was obvious reduction in group B. The absorption rate of bone grafts of ramus 3 months,6months and 12 months after operation was 7.9%,19.8% and 34.7%.
5. The average absorption rate of the bone grafts showed no significant difference between group C and group D 3 months,6months and 12 months after operation. The rate was 0.8%-4.7% more in group D. The B and B'spot of bone grafts were absorbed much heavier in group D, and the rate was 4%-16.5% more than in group C.
Conclusion
1. The position of condylar process showed no change in the condyles reserved cases, while the condylar process of the normal side moved forward in the condyles removed cases after operation.
2. Comparing with one bone graft, the absorption rate was higher in the position of two bone grafts contacted。
3. The preservation of condylar process can keep the height the bone grafts.
4. The average absorption rate of the bone grafts showed no significant differences between the operation with intra-oral route and the outside route.
引文
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31. Dechamplain RW:Mandibular reconstruction. [J].J Oral Surg,1973,31:448
32. Kruger E. Kaumholz K. Results of bone grafting after rigid fixation. [J].J Oral Maxillofac.Surg,1984,42:491
33.崔念晖,张益,俞光岩等下颌骨缺损自体游离髂骨移植后骨吸收及其影响因素的临床分析[J].现代口腔医学杂志2000,14(3)：182-184
34.唐海阔,赵怡芳.不同骨受植床游离植骨成骨能力比较的实验研究[J].临床口腔医学杂志2005,21(5)：287-289
35.邱蔚六.口腔颌面外科理论与实践[M].北京：人民卫生出版社,1998：552-561.
36.杨志明.修复重建外科学[M].北京：人民卫生出版社,2001：247.
37.王冬,杨壮群,虎小毅。下颌骨体部缺损游离骼骨块移植不同连接方式的应力分析[J].华西口腔医学杂志2007,25(4)：345-348
38. Tidstorm KD,Keller EE.Reconstruction of mandibular discontinuity with autogenous illac bone graft.report of 34 consecutive patients.[J]. J Oral Maxillofac Surg 1990,48:336
39. Katakura A.Shibbahara T.Noma H. et al.Material analysis of AO plate fracture cases. [J]. J Oral Maxillofac Surg 2004,62:348-352
40. Kudo K,.Fujioya Y. Review of bone grafting for reconstruction of discontinuity defects of the mandible [J].J Oral Surg,1978,36:791
41. Sailer HF. Experiences with intra-oral partial resection and simultaneous reconstruction of the mandible in preoperatively non-infected cases. [J]. J Maxillofac Surg.1974 2(4):173-178.
1.刘宝林.浅谈颌骨缺损功能重建应注意的问题[J].口腔颌面外科杂志2007,17(4)：293-296
2.Urken ML.Weinberg H.Vickery C. Oromandibular reconstruction using microvascular composite free flaps [J] Arch Otolaryngol Head Neck Surg,1991, 117 (7):733-744
3. Jewer DD.Boyd JB.Manktelow RT.Orofacial and mandibular reconstruction with the iliac crest free flap:a review of 60 cases and a new method of classification [J]. Plast Reconstr Surg.1989,84(3):391-403
4.David DJ.Tan E.Katsaros J.Mandibular reconstruction with vascularized iliac crest:a 10-year experience [J]. Plast Reconstr Surg.1988,82(5):792-803
5. Hamada Y, Kondoh T, Kamei K, et al. Disc mobility and arthroscopic condition of the temporo mandibular joint associated with long-termmandibular discontinuity.[J] J Oral Maxillofac Surg,2001,59(9):1002-1006
6.王志平.吴汉江.朱兆夫下颌骨缺损的外形修复与功能重建[J].口腔颌面外科杂志2002,12(1)：61-63
7.张益,张建国,俞光岩.钛板修复下颌骨缺损的远期失败因素分析.中华口腔医学杂志,1999,34(4)：205-207
8. Wells MD. Mandibular reconstruction using vascularized bone graft. [J]. J Oral Maxillofac Surg,1996,54:883-888
9. Boyd JB, Mullholland RS, Davidson J, et al. The free flap and platein oromandibular reconstruction:long-term review. [J]. Plast ReconstSurg,1995, 95:1018-1028
10. Joel Ferri.Benoit Piot.Blandline Ruhin.et al. Advantages and limitations of the fibula free flap in mandibular reconstruction. [J]. J Oral Maxillofac Surg,1997, 55:440-448
11.崔念晖,张益,俞光岩.下颌骨缺损自体游离髂骨移植后骨吸收及其影响因素的临床分析[J].现代口腔医学杂志2000,14(3)：182-184
12.Tideman H. Samman N.Cheung LK.Immediate reconstruction following maxillectomy:a new method [J]. Inl J Oral Maxillofac Surg,1993,22(4): 221-225.
13. Hugo L.Obwegeser.Simultaneous resection and reconstruction of parts of the mandible via the intraoral route in patients with and without gross infections [J]. Oral Surg Oral Med and Oral Pathol 1966,6(21):693-705
14. Stroud SW.Fonseca RJ.Sander GW Healing of interposition autologous bone grafts after maxillary osteotomy [J]. J Oral Surg 1980,38(5):878-888
15. Phemister DB The fate of transplanted bone and regenarative power of its various constituents [J]. Surgery Gynecology 1914,19:303
16. Goldberg VM.Stevenson S Natural history of autografts and allografts Clin Orthop Relat Res,1987,225(9):7
17.Moore JB.Mazur MD A biomechanical comparision of vascularized and conventional autogenous bone grafrs. [J].Plast Reconstr Surg.1984,73 (2):382-386.
18. Craig G Early osteogenesis in compact bone isograft:A quantitative syudy of the contributions of the different graft cells.[J].Calcif Tissue Int,1979,29(2):225-237
19.林成, 刘宝林, 刘晓辉等非血管化游离髂骨移植血供重建的动物实验研究[J].临床口腔医学杂志2007,23(7)：387-389
20.Will LA.Joondeph DR.Hohl TH Condylar position following mandibular advancement its relationship to relapse [J].J Oral Maxillofac Surg 1984,42:578
21. Moore KE.Gooris PJ.Stoelinga PJ.The contributing role of condyle resorption to skeletal relapse following mandibular advancement surgery:report of five cases. [J].J Oral Maxillofac Surg 1991,49:448
22. Sherwood JK.Riley SL.Palazzolo R A three-dimensional osteochondral composite scaffold for articular cartilage repair. [J].Biomaterials 2002,23:4739-4751
23.龚振宇,刘彦普,周树夏等基于反求工程和快速原型的下颌骨缺损的修复[J].中华口腔医学杂志2004,39(1)：9-11
24.刘彦普,龚振宇,何黎升等基于快速成型技术的下颌骨缺损重建术[J].实用口腔 医学杂志2003,19(5)：523-525
25.唐海阔,赵怡芳.不同骨受植床游离植骨成骨能力比较的实验研究[J].临床口腔医学杂志2005,21(5)：287-289
26.汪良能,高学书.整形外科学[M].北京：人民卫生出版社,1989：51.
27.邱蔚六.口腔颌面外科理论与实践[M].北京：人民卫生出版社,1998：552-561.
28.杨志明.修复重建外科学[M].北京：人民卫生出版社,2001：247.
29.王冬,杨壮群, 虎小毅。下颌骨体部缺损游离髂骨块移植不同连接方式的应力分析[J].华西口腔医学杂志2007,25(4)：345-348
30. Dechamplain RW:Mandibular reconstruction. [J].J Oral Surg,1973,31:448
31. Kruger E. Kaumholz K. Results of bone grafting after rigid fixation. [J].J Oral Maxillofac.Surg,1984,42:491
32.Tidstorm KD,Keller EE.Reconstruction of mandibular discontinuity with autogenous illac bone graft.report of 34 consecutive patients.[J]. J Oral Maxillofac Surg 1990,48:336
33. Kennady MC.Tucker MR.Lester GE Histomorphometric evaluation of stress shielding in mandibular continuity defects treated with rigid fixation plates and bone grafts [J].J Oral Maxillofac.Surg,1989,18:170
34.潘瑾,张益,俞光岩下颌骨缺损游离髂骨移植骨块的准确就位及坚固固定[J].现代口腔医学杂志2001,15(1)：182-184
35. Katakura A.Shibbahara T.Noma H. et al.Material analysis of AO plate fracture cases. [J]. J Oral Maxillofac Surg 2004,62:348-352
2. Boyd JB, Mullholland RS, Davidson J, et al. The free flap and platein oromandibular reconstruction:long-term review. [J]. Plast ReconstSurg,1995, 95:1018-1028
3. Joel Ferri.Benoit Piot.Blandline Ruhin.et al. Advantages and limitations of the fibula free flap in mandibular reconstruction. [J]. J Oral Maxillofac Surg,1997, 55:440-448
4. Hugo L.Obwegeser.Simultaneous resection and reconstruction of parts of the mandible via the intraoral route in patients with and without gross infections [J]. Oral Surg Oral Med and Oral Pathol 1966,6(21):693-705
5. Tideman H.Samman N.Cheung LK. Immediate reconstruction following maxillectomy:a new method [J]. Inl J Oral Maxillofac Surg,1993,22(4): 221-225.
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