自体骨移植修复重建下颌骨缺损的临床研究(1)
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[摘要] 目的 探讨自体骨移植修复重建下颌骨缺损的方法与效果。方法 回顾性分析37例自体骨移植修复下颌骨缺损修复与重建患者的临床资料，其中游离肋骨l8例，游离髂骨15例，吻合血管的腓骨瓣4例，分析术后近远期修复效果。结果游离肋骨、游离髂骨、吻合血管的腓骨瓣的移植成功率分别达88.89%、93.33%、100.00%。随访1～5年，患者对外形较满意，其中16例进行了活动义齿修复，8例延期牙种植体修复恢复，咀嚼功能良好。结论 游离髂骨及肋骨移植修复下颌骨缺损手术操作简单，但有不同程度的吸收现象。吻合血管骨移植修复效果较好，但技术要求较高。在选择修复方法时，应综合考虑制定个体化的修复重建方案，力争达到最佳的修复效果。
[关键词]下颌骨缺损；骨移植；修复；牙种植体
[中图分类号]R782.05 [文献标识码] B [文章编号] 1673-9701(2011)27-15-02
Repair andReconstruction of Mandibular Defects by Autologous Bone Graft
GAO Keyang
Hangzhou Stomatological Hospital of Zhejiang Province，Hangzhou 310002, China
[Abstract] Objective To explore the measure and effect of repairing and reconstructing mandibular defects by autologous bone graft.Methods Retrospectively analyzing 37 case’s clinical data that were repaired or reconstructed for mandibular defects by autologous bone graft, including 18 cases of free rib, 15 cases of free iliac bone, 4 cases of vascularized fibula flap, then analyzing postoperative effect of recent and long-term. Results Transplant success rates of free ribs, free iliac bone and vascular anastomosis fibular flap were 88.89%, 93.33% and 100% respectively. Followed up for 1 to 5 years, patients were satisfactory wtih appearance. Among them, 16 cases were repaired by movable false tooth, and 8 cases were repaired by delayed dental implants, and their masticatory function were good. Conclusion The surgery of repairing mandibular defects by free ribs and free iliac bone have the advantages of simple operation, but have some absorption phenomenon. Vascularized bone grafting for repairing has good effect,but requires higher technics. So on selecting repair measure, we should formulate individualized rehabilitation program after comprehensive consider to achieve the best results.
[Key words] Mandibular defects；Bone transplant；Repair；Dental implants
下颌骨缺损在临床上较常见，多为肿瘤切除术后所致，少数由外伤等原因导致，导致颜面畸形及咀嚼、吞咽等功能障碍[1]。下颌骨缺损的修复旨在重建下颌骨的完整性，恢复下颌的功能和面部外形，并为以后的牙列修复或牙种植创造条件。目前，修复下颌骨缺损的方法有多种，如非生物代用品植入、同种异体骨、异种骨、病变下颌骨切除冷冻和煮沸再植，自体骨移植等[2]。但是在修复方法的选择上，应做到因人而异、因病制宜 ......
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