Li Jun, Sun Jian, He Yue, Weng Yan-qiu, Jiang Ji-dang
Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, School of Stomatology, Shanghai Second Medical University, Shanghai 200011, China.
Shanghai Kou Qiang Yi Xue. 2005 Aug;14(4):355-8, 369.
To introduce an axial split osteotomy of free fibular flap for mandible angle reconstruction and discuss its indications and surgical technique.
16 patients underwent axial split osteotomy of free fibular flap(12 males and 4 females, aged from 23 to 62). 11 patients with benign tumors (8 ameloblastomas and 3 odontogenic keratocyst), 3 patients with osteoradionecrosis, and 2 patients with secondary mandibular deformity were included. The length of free fibular flap ranged from 10-17 cm (mean 14.6 cm). The length of the vascular pedicel ranged from 5-11 cm (mean 8.2 cm). The fibular flap harvested was performed in routine manner. After elevating the periosteum and performing minimal dissection at osteotomy site only, axial splitting was performed using an oscillating saw. The first osteotomy was made on the external surface of the fibula, perpendicular to the main axis of the bone down to the level of the medullary canal. The second osteotomy was made along the main axis of the bone. The length of this osteotomy was between 2 and 3 cm. The last osteotomy was made perpendicular to the internal surface at one junction of the anterolateral and posteromedial surfaces down to the medullary canal, as was done for the first osteotomy. Then the harvested flap was contoured, which was achieved by raising the two bone segments and fitting them together. The angulation was 120 degrees.
16 flaps were monitored by Doppler ultrasound postoperatively and examined by colored ultrasound 3 months, 6 months after operation. The results revealed that the recipient sites healed primarily without complications.
Axial split osteotomy is a reliable technique with maximum contact surface for bone union, and less bone loss, which can lengthen the transplanted bone to a certain extent. It is suitable especially for reconstruction of the defect of the angle of the mandible.
介绍用于下颌角重建的游离腓骨瓣轴向劈开截骨术，并探讨其适应证及手术技术。
16例患者接受游离腓骨瓣轴向劈开截骨术（男12例，女4例，年龄23至62岁）。其中包括11例良性肿瘤患者（8例成釉细胞瘤和3例牙源性角化囊肿）、3例放射性骨坏死患者以及2例继发性下颌骨畸形患者。游离腓骨瓣长度为10 - 17厘米（平均14.6厘米）。血管蒂长度为5 - 11厘米（平均8.2厘米）。腓骨瓣的切取采用常规方法。在骨膜掀起后，仅在截骨部位进行最小限度的解剖，然后使用摆动锯进行轴向劈开。第一次截骨在腓骨外表面进行，垂直于骨的主轴直至髓腔水平。第二次截骨沿骨的主轴进行。此次截骨长度在2至3厘米之间。最后一次截骨在腓骨前外侧和后内侧表面交界处的内表面垂直进行直至髓腔，如同第一次截骨那样。然后对切取的瓣进行塑形，通过抬起两个骨段并使其贴合在一起实现。成角为120度。
术后用多普勒超声对16个瓣进行监测，并在术后3个月、6个月行彩色超声检查。结果显示受区一期愈合，无并发症。
轴向劈开截骨术是一种可靠的技术，骨愈合接触面最大，骨丢失少，能在一定程度上延长移植骨。尤其适用于下颌角缺损的重建。
