Kashiwa Katsuhiko, Kobayashi Seiichiro, Nohara Takaya, Yasuoka Tomoyuki, Hosoya Yuko, Fujiwara Hitomi, Honda Takayuki, Kimura Hiroaki
Department of Plastic, Reconstructive and Aesthetic Surgery, Iwate Medical University, Faculty of Medicine, Morioka, Japan.
J Craniofac Surg. 2008 Nov;19(6):1571-6. doi: 10.1097/SCS.0b013e3181897351.
The efficacy of distraction osteogenesis in an irradiated area is controversial, although this procedure is now widely used in the field of craniomaxillofacial surgery. We report the clinical results from 4 patients with mandibular defects treated by lengthening of the irradiated mandibles. All patients had a mandibular defect caused by ablation of a malignant tumor. They had undergone radiotherapy at a total dose of 30 to 50 Gy to the surgical site after tumorectomy. Distraction osteogenesis was used as the secondary reconstruction method in 6 sites of the remaining irradiated mandibles and in 1 site of the transferred vascularized scapula after radiotherapy. The transported segment was obtained by corticotomy with an initial gap of 0 to 2 mm, and internal extension plates were used. Distraction was commenced after a latency period of 7 to 10 days and performed at the rate of 0.25 to 1.0 mm/d. The total amount of distraction and consolidation periods ranged from 15 to 25 mm and 120 to 193 days, respectively. In 5 of the 6 sites in the remaining irradiated mandibles, satisfactory bone formation in the distraction gap was observed, although a fracture after new bone formation was observed in 1 site. Fibrous callus formation was observed in 1 irradiated site only, and satisfactory results were obtained in another site of transferred vascularized scapula in the same patient. From these experiences, we believe that distraction may provide a reconstruction option for mandibular defects even under irradiated conditions because the procedure is simple and less invasive.
尽管牵张成骨术目前在颅颌面外科领域广泛应用，但其在放疗区域的疗效仍存在争议。我们报告了4例接受放疗后下颌骨延长治疗的下颌骨缺损患者的临床结果。所有患者均因恶性肿瘤切除导致下颌骨缺损。肿瘤切除术后，手术部位接受了总量为30至50 Gy的放疗。牵张成骨术被用作剩余放疗后下颌骨6个部位以及放疗后带血管蒂肩胛骨转移部位1个部位的二期重建方法。通过骨皮质切开术获得转移骨段，初始间隙为0至2 mm，并使用了内固定延长板。在7至10天的延迟期后开始牵张，牵张速率为0.25至1.0 mm/天。牵张总量和巩固期分别为15至25 mm和120至193天。在剩余放疗后下颌骨的6个部位中的5个部位，牵张间隙内观察到满意的骨形成，尽管在1个部位观察到新骨形成后发生了骨折。仅在1个放疗部位观察到纤维性骨痂形成，在同一患者的另一个带血管蒂肩胛骨转移部位获得了满意的结果。基于这些经验，我们认为即使在放疗条件下，牵张成骨术也可能为下颌骨缺损提供一种重建选择，因为该手术操作简单且侵入性较小。
