Akbay Ercan, Aydogan Fusun
Department of Otorhinolaryngology Head & Neck Surgery, Mustafa Kemal University Medical Faculty, Hatay, Turkey.
Department of Nuclear Medicine, Mustafa Kemal University Medical Faculty, Hatay, Turkey.
Auris Nasus Larynx. 2014 Feb;41(1):56-62. doi: 10.1016/j.anl.2013.07.002. Epub 2013 Jul 30.
The aim of this study is to discuss the use of non-vascularized bone grafts in mandibular reconstruction and their viability.
In this study, 11 patients with mandibular defect treated by surgery using non-vascularized bone grafts between 2011 and 2012 were reviewed. All patients underwent preoperative and postoperative 3-dimensional computerized tomography scan for surgical planning and evaluation of success after surgery. Grafts were used for defects caused by mandible tumors in 2 patients and firearm injuries in 9 patients. Reconstruction was achieved by using various non-vascularized bones, including iliac crest, fibula and scapula. To improve graft supply, periosteum of the grafts was spared and multiple bores were created on the graft during surgery by drilling. At the postoperative period, Dextran 70 and Bencyclane Hydrogen Fumarate was given in order to enhance micro-circulation. On the postoperative day 5, 15 and 30, Tc-99m methylenediphosphonate scintigraph, blood-pool single photon emission computed tomography and it's bone phase were performed in order to assess viability of bone grafts greater than 3cm.
Mean age was 32. 27±13.33 (min=10-max=56). Of the 11 patients, 10 (90. 9%) were men and 1 (9. 1%) was woman. Mandibular defects were at right corpus in 3 patients; at right ramus and angulus in 1 patient; at left corpus in 1 patient; at left ramus and angulus in 1 patient; at left ramus, angulus and corpus in 1 patient; left parasymphysis in 1 patient; at bilateral corpus in 1 patient; at symphysis in 1 patient and at whole segment from right corpus to left one in 1 patient. The following grafts were used: iliac crest grafts in 9 cases, scapula graft in 1 case and fibula graft in 1 case. The smallest graft used was 1×2cm in size, while the greatest, single piece graft was 7cm in size. The greatest multi-piece graft was a fibula graft of 14cm in length. All grafts with a size of 3 and 7cm had been supplied at the end of first month. No bone resorption or donor site morbidity was observed in any patient.
Non-vascular bone grafts can be successfully used in isolated bone defects of mandible in case of appropriate graft selection for fitting anatomical region. A single piece iliac crest grafts up to 7cm can be revascularized in long-term.
本研究旨在探讨非血管化骨移植在下颌骨重建中的应用及其可行性。
回顾性分析2011年至2012年期间11例采用非血管化骨移植手术治疗下颌骨缺损的患者。所有患者术前行三维计算机断层扫描，用于手术规划及术后效果评估。2例患者因下颌骨肿瘤导致骨缺损，9例因火器伤导致骨缺损。采用多种非血管化骨进行重建，包括髂嵴、腓骨和肩胛骨。为改善骨移植的血供，术中保留骨膜，并通过钻孔在骨移植块上制造多个小孔。术后给予低分子右旋糖酐和延胡索酸苄环己铵以改善微循环。术后第5天、15天和30天，进行锝-99m亚甲基二膦酸盐骨闪烁显像、血池单光子发射计算机断层扫描及其骨显像，以评估大于3cm的骨移植块的存活情况。
患者平均年龄为32.27±13.33岁（最小10岁，最大56岁）。11例患者中，10例（90.9%）为男性，1例（9.1%）为女性。下颌骨缺损部位：右侧体部3例；右侧升支及角部1例；左侧体部1例；左侧升支及角部1例；左侧升支、角部及体部1例；左侧颏部1例；双侧体部1例；正中联合部1例；右侧体部至左侧整个节段1例。采用的骨移植如下：髂嵴移植9例，肩胛骨移植1例，腓骨移植1例。使用的最小骨移植块尺寸为1×2cm，最大的单块骨移植块尺寸为7cm。最大的多块骨移植是一块长14cm的腓骨移植。所有尺寸为3cm和7cm的骨移植块在第一个月末均已获得血供。未观察到任何患者出现骨吸收或供区并发症。
在为适应解剖区域选择合适的骨移植块的情况下，非血管化骨移植可成功用于下颌骨孤立性骨缺损。长达7cm的单块髂嵴移植骨可长期实现血管化。
