游离皮瓣重建治疗颌骨放射性骨坏死：疗效及成功预测因素。
Free flap reconstruction for osteoradionecrosis of the jaws--outcomes and predictive factors for success.
机构信息
The Head and Neck Center, Rochester, New York, USA.
出版信息
Head Neck. 2011 Mar;33(3):424-8. doi: 10.1002/hed.21463.
BACKGROUND
The purpose of this study was to determine factors to predict the success of free flap surgery in the treatment of osteoradionecrosis (ORN).
METHODS
Univariate analysis of overall and flap complications was performed. The effect of time to ORN, and the time interval between ORN to reconstruction was evaluated.
RESULTS
Fifty-five flaps on 53 patients for ORN were done with a 90% resolution rate. Univariate parameter analysis was significant for infield mandibulotomy. An increased time interval from radiation therapy (XRT) to ORN development significantly predicted for flap-specific complications and flap loss (p < .05). Increased time from ORN diagnosis to flap surgery resulted in greater length of bone involvement (p = .01). Anastomotic complications occurred in 13 cases resulting in 7 complete flap losses.
CONCLUSION
An increased risk of complication was encountered with greater time from XRT to ORN. Thus, in patients developing ORN long after treatment, surgery should be accordingly more aggressive.
背景
本研究旨在确定预测游离皮瓣手术治疗放射性骨坏死（ORN）成功的因素。
方法
对总体和皮瓣并发症进行单因素分析。评估 ORN 至重建的时间以及 ORN 至重建的时间间隔的影响。
结果
53 例患者的 55 个皮瓣用于 ORN，缓解率为 90%。场内下颌切开术的单因素参数分析具有显著意义。从放射治疗（XRT）到 ORN 发展的时间间隔增加，显著预测了皮瓣特异性并发症和皮瓣丧失（p <.05）。从 ORN 诊断到皮瓣手术的时间增加导致骨受累长度增加（p =.01）。吻合口并发症发生在 13 例中，导致 7 例完全皮瓣丧失。
结论
从 XRT 到 ORN 的时间增加会增加并发症的风险。因此，对于治疗后长时间发生 ORN 的患者，手术应更加积极。
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