摘要
目的:分析游离腓骨瓣重建下颌骨缺损患者术后义齿修复情况,并对义齿功能进行评价。方法:收集2015年1月至2020年12月期间154例因炎症、外伤、肿瘤等原因实施下颌骨节段切除,并采用血管化游离腓骨瓣修复下颌骨缺损的患者,回顾相关资料并随访调查患者义齿修复的相关情况,同时对义齿修复功能评价的各指标进行专家权威赋值,获得义齿功能评分。采用SPSS 18.0软件对纳入研究患者的基本信息和患者义齿修复情况进行统计分析。结果:游离腓骨瓣修复下颌骨缺损患者术后义齿修复率为17.5%,其中,下颌骨良性肿瘤患者采用腓骨瓣修复的术后义齿修复率为25.0%(18/72例),明显高于恶性肿瘤患者的术后义齿修复率11.0%(9/82例,P<0.05)。缺损累及髁突和不累及髁突的患者在义齿修复率和义齿功能评分上差异均无统计学意义(P>0.05)。种植义齿修复患者的义齿功能评分显著高于活动义齿修复的患者(P<0.05)。根据Brown分类,缺损累及下颌骨前牙区患者的义齿功能评分显著高于未累及下颌骨前牙区的患者(P<0.05)。因口内条件差而未行义齿修复的患者约占未行义齿修复患者总数的37.9%,是未行义齿修复的最主要原因。结论:游离腓骨瓣重建下颌骨缺损的义齿修复情况与肿瘤性质、口内条件等关系密切,种植义齿的临床修复效果更佳,是未来颌骨重建后义齿修复的更优选择。
Objective:To evaluate the postoperative denture restoration and denture function in patients with mandibular defect reconstructed with vascularized free fibula flap.Methods:In the study,154 patients who underwent mandibular segment resection and used vascularized free fibula flap to repair mandibular defects due to inflammation,trauma and tumor from January 2015 to December 2020 were collected.These patients had common inclusion criteria which were stable occlusal relationship before operation,segmental defects of mandibular bone caused by lesions of mandible and adjacent parts(such as floor of mouth,tongue,cheek),free fibula flap used for repair and surviving after operation.Relevant data were reviewed and situation of denture restoration was followed up.A questionnaire related to denture functional evaluation had been proposed for those who had completed the denture rehabilitation.The evaluation index of denture restoration function was assigned by expert authority to obtain the denture function score.SPSS 18.0 software was used for statistical analysis of the basic information of the patients included in the study and the denture restoration of the patients.Results:The rate of postoperative denture restoration in the patients with mandibular defects repaired by free fibula flap was 17.5%,and the rate of postoperative denture restoration in the patients with benign mandibular tumors was 25.0%(18/72),which was significantly greater than that in the patients with malignant tumors 11.0%(9/82,P<0.05).There was no significant difference in denture function score between the patients with condylar defect and those without condylar defect in denture repair rate and denture function score(P>0.05).The functional score of implant denture was significantly greater than that of removable denture(P<0.05).According to Brown classification,the denture function score of the patients with the defect invo-lving the anterior mandibular region was significantly greater than that of the patients without the anterior mandibular region involved(P<0.05).The poor oral conditions,such as less amount of remaining teeth,insufficient retention strength,large mobility of soft tissue in the surgical area,poor oral vestibular groove condition became the main reason of not receiving denture restoration(37.86%).Conclusion:The denture rehabilitation of mandibular defect reconstructed with vascularized free fibula flap is closely rela-ted to pathological properties and oral conditions.The clinical outcome of implant denture has been confirmed effectively and it is a better choice for future denture restoration after mandibular reconstruction.
作者
王聪伟
高敏
于尧
章文博
彭歆
WANG Congwei;GAO Min;YU Yao;ZHANG Wenbo;PENG Xin(Department of Oral and Maxillofacial Surgery,Peking University School and Hospital of Stomatology&National Center of Stomatology&National Clinical Research Center for Oral Diseases&National Engineering Research Center of Oral Biomaterials and Digital Medical Devices&Beijing Key Laboratory of Digital Stomatology&NHC Research Center of Engineering and Technology for Computerized Dentistry,Beijing 100081,China)
出处
《北京大学学报（医学版）》
CAS
CSCD
2024年第1期66-73,共8页
Journal of Peking University:Health Sciences
关键词
游离组织瓣
腓骨移植
下颌骨重建术
牙种植体
Free tissue flaps
Fibula transplantation
Mandibular reconstruction
Dental implants
