Chepeha Douglas B, Teknos Theodoros N, Fung Kevin, Shargorodsky Josef, Sacco Assuntina G, Nussenbaum Brian, Jones Lamont, Eisbruch Avraham, Bradford Carol R, Prince Mark E, Moyer Jeffrey S, Lee Julia S, Wolf Gregory T
Department Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan 48109-0312, USA.
Head Neck. 2008 Jun;30(6):709-17. doi: 10.1002/hed.20776.
A quasi-experimental retrospective study was undertaken to evaluate a new concept of free tissue volume restoration combined with bridging reconstruction plate (compartment approach) to reduce plate-related complication rates.
We evaluated 40 patients with large lateral mandible defects and associated complex soft tissue defects reconstructed with a revascularized soft tissue flap and titanium hollow screw reconstruction plates. A case-control comparison was performed based on reconstruction type: restoration of soft tissue defect (conventional approach-group 1) versus over-reconstruction of soft tissue defect (compartment approach-group 2).
Plate exposure rate was 6 of 16 (38%) in group 1 versus 2 of 24 (8%) in group 2, and the difference was statistically significant (p = .04). The mean time to exposure was 10 months. Plate fracture rate was 6 of 23 (26.1%) in dentulous patients versus 1 of 17 (5.9%) in edentulous patients. Gastrostomy tube dependence was 6 of 16 (38%) in group 1 versus 6 of 24 (25%) in group 2.
The "compartment approach" reduces plate exposure rate and gastrostomy tube dependence. Revascularized osseocutaneous reconstruction is still required in dentulous patients.
开展了一项准实验性回顾性研究，以评估游离组织容积恢复联合桥接重建钢板（间隔法）这一新概念，以降低与钢板相关的并发症发生率。
我们评估了40例伴有复杂软组织缺损的下颌骨外侧大缺损患者，这些患者采用了带血管蒂软组织瓣和钛空心螺钉重建钢板进行重建。根据重建类型进行病例对照比较：软组织缺损修复（传统方法 - 第1组）与软组织缺损过度重建（间隔法 - 第2组）。
第1组16例中有6例（38%）发生钢板外露，而第2组24例中有2例（8%），差异具有统计学意义（p = 0.04）。平均外露时间为10个月。有牙患者的钢板骨折率为23例中的6例（26.1%），无牙患者为17例中的1例（5.9%）。第1组16例中有6例（38%）依赖胃造瘘管，第2组24例中有6例（25%）。
“间隔法”可降低钢板外露率和胃造瘘管依赖率。有牙患者仍需要带血管蒂骨皮瓣重建。
