Department for Cranio- and Maxillofacial Surgery of Heinrich Heine University Düsseldorf, Moorenstr. 5 (Geb. 18.73), D-40225 Düsseldorf, Germany.
In Vivo. 2011 Sep-Oct;25(5):795-9.
Treatment of intraoral malignant tumors often leads to continuity defects of the mandible. Whereas the use of free vascularised flaps has shortcomings regarding donor site morbidity and a worse-fitting bone geometry, the nonvascularized iliac crest graft could be an alternative option. The purpose of this study was to describe the treatment outcome with nonvascularized iliac crest grafts over a 10-year period and to determine possible limitations of their use.
Eighty-four patients with bicortical nonvascularized iliac crest grafts for mandibular reconstruction were examined at least one year after reconstruction. Patients' records and the radiological and/or surgical data were analyzed.
Sixty-three patients (75%) showed complete healing, in 20 patients the treatment was not successful and in one patient the treatment result was unclear. Interestingly, comparing the successfully and the unsuccessfully treated patients, only the irradiation dose played a crucial role. Neither defect length nor defect localisation, nor time interval between resection and reconstruction were statistically significant parameters in graft success. Comparing only patients with malignancies, the non-irradiated patients had a higher success rate (77.3%).
The nonvaslcularized iliac crest graft seems to be a reasonably reliable treatment option for reconstruction of mandibular defects up to about 5-6 cm in size. Radiotherapy is a strong confounder reducing the success rate. Necessary constraints are sufficient soft tissue conditions. However, primary reconstruction by free flaps (e.g. fibula flap) has a higher success rate in literature and should be preferred whenever possible.
口腔内恶性肿瘤的治疗常导致下颌骨连续性缺损。游离血管化皮瓣的使用存在供区并发症和骨几何形状不佳的缺点，而非血管化髂嵴移植则可能是一种替代选择。本研究的目的是描述 10 年来使用非血管化髂嵴移植治疗的结果，并确定其使用的可能限制。
84 例接受双皮质非血管化髂嵴移植进行下颌骨重建的患者在重建后至少 1 年接受检查。分析患者的病历和影像学及/或手术数据。
63 例患者（75%）完全愈合，20 例治疗不成功，1 例治疗结果不清楚。有趣的是，比较成功和不成功治疗的患者，只有照射剂量起着关键作用。在移植成功方面，缺损长度、缺损定位、切除与重建之间的时间间隔均无统计学意义。仅比较恶性肿瘤患者，未接受放疗的患者成功率更高（77.3%）。
非血管化髂嵴移植似乎是一种合理可靠的治疗选择，适用于重建大小约 5-6cm 的下颌骨缺损。放疗是降低成功率的一个强混杂因素。必要的限制是足够的软组织条件。然而，文献中游离皮瓣（如腓骨皮瓣）的一期重建成功率更高，在可能的情况下应优先选择。
