摘要
目的探讨血管化腓骨移植在修复颌面部缺损中的应用价值。方法共纳入45例各种原因造成的颌面部缺损患者，均采用血管化腓骨移植进行修复。所有患者均记录相关疾病病史、受区血管和组织瓣成活情况。结果术后随访观察患者3～6个月。所有患者出院时均能经口腔进食，未有明显障碍，术后未出现颌面部不对称、健侧咬颌偏斜等情况，口腔颌面部外形和功能均基本恢复正常。口腔全景片显示移植的腓骨与颌骨骨性愈合良好，未发生骨不连、骨坏死、钛板排异及断裂。三维CT扫描显示颌骨外形恢复良好。术后出现1例小腿伤口渗液，1例颈部伤口积液，均经换药和对症处理后伤口二期愈合，其余患者伤口均为一期愈合。未出现游离组织瓣坏死现象及供区小腿明显功能障碍。结论在修复颌面部缺损中采用血管化腓骨移植，患者术后的口腔颌面部外形和功能均基本恢复正常，且并发症发生率低，游离组织瓣的存活率高，能够满足患者对于术后口腔颌面部形态和功能的要求，值得临床推广应用。
Objective To explore the application value of vascularized fibular graft in the repairment of maxillofacial defects. Methods Forty-five patients with maxillofacial defects caused by various reasons were enrolled and treated by vascularized fibular graft. The related disease history, survival situation of blood vessels and tissue flaps of all the patients were recorded. Results All the patients were followed up for 3-6 months after surgery. All the patients could eat by mouth and without no obvious obstacle. There was no facial asymmetry,healthy side bite jaws deflection and so on. The maxillofacial appearance and functions almost returned back to normal. Oral panoramic radiography showed that the osseous healing of transplanted fibular and mandibular was good, and there was no bone nonunion, osteonecrosis, titanium plate rejection or fracture happened. Three-dimensional CT scan revealed that the recovery of mandibular appearance was good. There was 1 case with leg wound drainage and 1 case with cervical wound effusion, which were all healed after the second phase by dressing change and necessary treatment. The rest of the patients were all healed at the first phase. There was no free tissue flap necrosis and calf obvious dysfunction. Conclusions Using vascularized fibular graft for the repairment of maxillofacial defects,the maxillofacial appearance and functions of patients almost return to normal after surgery. The surgery can satisfy the requirements of patients on postoperative oral and maxillofacial appearance and function with lower incidence of complications and higher survival rate of free tissue flap. Therefore, it is worthy of clinical application.
出处
《中国医师进修杂志》
2012年第21期32-34,共3页
Chinese Journal of Postgraduates of Medicine
关键词
上颌面部损伤
血管化
腓骨移植
临床分析
Maxillofacial injuries
Vascularization
Fibular graft
Clinical analysis
