Department of Craniomaxillofacial Surgery, University Hospital of Zurich, Zurich, Switzerland.
Microsurgery. 2011 Feb;31(2):98-103. doi: 10.1002/micr.20858. Epub 2011 Jan 28.
Microsurgical revascularized fibula graft is a standard for the reconstruction of mandible or maxilla after major resection. Usually, screwed implants are inserted as a second procedure for dental rehabilitation. A lot has been published about the advantages of vascularized bone grafts, but until now there is only little information about long-term viability of inserted bone grafts.
In this study, previously inserted vascularized fibula bone grafts were examined histologically. Bone biopsies were taken during dental implant insertion procedure in average of 19 months after insertion of bone grafts from 10 patients.
All bone biopsies showed partially or totally necrotic bone, although clinical examination and postoperative monitoring of the revascularized bone remained unremarkable.
The results of histological examination are surprising, due to the fact of previous insertion of a vascularized bone graft and pretended osseointegration of inserted dental implants with satisfying primary stability. Therefore, one would expect vital bone. For better understanding how much viability is really necessary for sufficient remodeling of inserted bone grafts for adequate functional load, further studies should be performed.
显微血管化腓骨移植是颌骨或上颌骨重建的标准方法，常用于大型切除术后。通常，在植入骨移植物后，通过二次手术植入螺钉式种植体进行牙齿修复。已有大量关于血管化骨移植物优势的出版物，但到目前为止，关于植入骨移植物的长期存活情况的信息仍然很少。
本研究对先前植入的血管化腓骨骨移植物进行了组织学检查。在 10 名患者中，平均在植入骨移植物后 19 个月，通过植入种植体的过程中进行了骨活检。
所有骨活检均显示部分或全部骨坏死，尽管临床检查和对再血管化骨的术后监测均无异常。
组织学检查的结果令人惊讶，因为先前已经植入了血管化骨移植物，并且插入的牙种植体被认为具有骨整合，具有令人满意的初始稳定性。因此，人们会期望有活力的骨。为了更好地了解对于充分的功能负荷，插入的骨移植物的适当重塑所需的实际存活量，应进行进一步的研究。
