Salinas Thomas J, Desa Valmont P, Katsnelson Alexander, Miloro Michael
Department of Prosthodontics, Mayo Clinic, Rochester, MN, USA.
J Oral Maxillofac Surg. 2010 Mar;68(3):524-9. doi: 10.1016/j.joms.2009.09.104.
The success of osseointegrated implants in the radiated fibula flap used for mandibular reconstruction is variable, and there are few long-term data available in the literature. The purpose of this study is to evaluate implant success in radiated fibula flaps and the native mandible after ablative tumor surgery.
The medical records of 44 patients who underwent resection and reconstruction of the mandible from 1994 to 2006 were reviewed retrospectively. A total of 206 implants were placed; 144 were placed in a fibula flap, and 92 were placed in the native mandible. Before implant placement, 22 patients (50%) received adjuvant tumoricidal doses of radiation therapy (>6,000 cGy). All patients who received radiation received a standard regimen of 20 preoperative and 10 postoperative hyperbaric oxygen treatments. The follow-up period ranged from 4 to 108 months (mean, 41.1 months). Comparisons were made between groups regarding long-term implant success based on several variables.
Implants were considered to be successful if there was no radiographic evidence of peri-implant bone loss and if they were clinically osseointegrated. Of 206 implants, 31 failed, with an overall success rate of 85%. The success rate of implants placed in fibula flaps was 82.4%, and the success rate in native mandibles was 88%. Most of the failures in the fibula (90%) occurred within the first 6 months after implant placement, whereas most of the failures in the mandible occurred after 6 months. The cumulative survival rate was 91.9%, and there was no difference in survival between implants placed in the fibula versus the native mandible or depending on whether the patient received radiation therapy.
Acceptable long-term implant success rates may be achieved in the radiated mandible with vascularized fibula flap reconstruction.
用于下颌骨重建的带血管蒂腓骨瓣中骨整合种植体的成功率各不相同，且文献中几乎没有长期数据。本研究的目的是评估在肿瘤切除术后的带血管蒂腓骨瓣及天然下颌骨中种植体的成功率。
回顾性分析1994年至2006年期间44例行下颌骨切除及重建手术患者的病历。共植入206枚种植体；144枚植入腓骨瓣，92枚植入天然下颌骨。在植入种植体前，22例患者（50%）接受了辅助性肿瘤杀伤剂量的放射治疗（>6000 cGy）。所有接受放疗的患者均接受了标准方案的术前20次和术后10次高压氧治疗。随访期为4至108个月（平均41.1个月）。基于多个变量对各亚组间的长期种植体成功率进行比较。
若影像学检查未发现种植体周围骨丢失且临床检查种植体实现骨整合，则认为种植成功。206枚种植体中，31枚失败，总体成功率为85%。植入腓骨瓣的种植体成功率为82.4%，天然下颌骨中的成功率为88%。腓骨瓣中大多数失败（90%）发生在种植体植入后的前6个月，而下颌骨中的大多数失败发生在6个月后。累积生存率为91.9%，植入腓骨瓣与天然下颌骨的种植体生存率无差异，也与患者是否接受放射治疗无关。
采用带血管蒂腓骨瓣重建放疗后的下颌骨可获得可接受的长期种植体成功率。
