van Gemert Johannes T M, van Es Robert J J, Rosenberg Antoine J W P, van der Bilt Andries, Koole Ron, Van Cann Ellen M
Department of Oral and Maxillofacial Surgery, Prosthodontics and Special Dental Care, University Medical Center Utrecht, Utrecht, The Netherlands.
J Oral Maxillofac Surg. 2012 Jul;70(7):1692-8. doi: 10.1016/j.joms.2011.08.024. Epub 2011 Nov 12.
To evaluate complications and success of mandibular reconstruction with free fibula flaps, iliac crest flaps, and forearm flaps with reconstruction plates and to evaluate dental rehabilitation after these reconstructions.
Eighty-three patients with segmental mandibular defects were included. Correlation analyses were used to determine the relationship between reconstruction type and clinical parameters with recipient-site complications and success. The dental rehabilitation was evaluated in successfully reconstructed survivors.
Multivariate analyses showed significant correlations between flap type and success (P < .0001). Of the patients, 51 (61%) were alive 2 years after the reconstruction. Mandibular reconstruction with a free forearm flap and reconstruction plate was associated with higher complication rates at the recipient site and higher failure rates compared with reconstruction with free vascularized bone flaps. Of the 32 successfully reconstructed survivors, 14 (44%) had a complete dental rehabilitation, of which 10 had dental implants and 4 did not. Only 6 (29%) of the edentulous survivors ultimately had an implant-supported prosthesis.
Reconstruction of the mandible with a free vascularized bone flap is superior to reconstruction with a free forearm flap with a reconstruction plate. Complete dental rehabilitation was reached in fewer than half of the surviving patients.
评估游离腓骨瓣、髂嵴瓣和带重建钢板的前臂瓣进行下颌骨重建的并发症及成功率，并评估这些重建术后的牙列修复情况。
纳入83例节段性下颌骨缺损患者。采用相关性分析确定重建类型及临床参数与受区并发症及成功率之间的关系。对成功重建的存活患者的牙列修复情况进行评估。
多因素分析显示皮瓣类型与成功率之间存在显著相关性（P <.0001）。患者中有51例（61%）在重建后2年存活。与带血管化游离骨瓣重建相比，带重建钢板的游离前臂瓣下颌骨重建受区并发症发生率更高，失败率也更高。在32例成功重建的存活患者中，14例（44%）实现了完全牙列修复，其中10例有牙种植体，4例没有。无牙列存活患者中只有6例（29%）最终采用了种植体支持的修复体。
带血管化游离骨瓣下颌骨重建优于带重建钢板的游离前臂瓣重建。存活患者中不到一半实现了完全牙列修复。
