Mertens Christian, Decker Christian, Engel Michael, Sander Anja, Hoffmann Jürgen, Freier Kolja
Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
J Craniomaxillofac Surg. 2014 Jul;42(5):e217-23. doi: 10.1016/j.jcms.2013.08.010. Epub 2013 Sep 27.
Patients with continuous bone defects of the mandible after ablative tumor surgery need bony reconstruction for proper function and aesthetics. Free microvascular reanastomized bone grafts provide a clinically proven option for such patients, yet the optimal source of donor tissue has not yet been established. The aim of this study was to evaluate and compare the bone volume stability of vascularized bone grafts, particularly in the early highly resorptive phase, from the iliac crest (DCIA) and the fibula and to assess the implantologic rehabilitations.
Thirty-six patients with mandibular continuity defects due to tumor resection were reconstructed by the use of vascularized bone grafts; 21 patients received DCIA flaps and 15 patients received a composite free fibular flap, depending on the size and location of the defect. Bone resorption was assessed using digital panographs. Radiographs were taken immediately after bone reconstruction, 6 months postoperatively, prior to implant surgery, and at prosthetic loading.
After a mean observation period of 6 months, vertical bone resorption was 6.79% for the patients of the iliac crest group (DCIA), 10.20% after 11 months, and 12.58% after 17 months. Fibular grafts showed a bone resorption of 5.30% after a mean observation time of 6 months, 8.26% after 11 months, and 16.95% after 17 months. Eighteen patients received 71 implants for implant-retained dental reconstructions.
Microvascular reanastomized bone grafts represent a reliable treatment option for reconstruction in cases of large defects of the mandible, with low graft resorption in the early healing phase. Additionally, the compared grafts provide sufficient bone volume to permit implant rehabilitation.
肿瘤切除术后下颌骨出现连续性骨缺损的患者需要进行骨重建以恢复正常功能和美观。游离微血管吻合骨移植为这类患者提供了一种经临床验证的选择，但最佳供体组织来源尚未确定。本研究的目的是评估和比较来自髂嵴（DCIA）和腓骨的带血管骨移植的骨体积稳定性，特别是在早期高吸收阶段，并评估种植修复情况。
36例因肿瘤切除导致下颌骨连续性缺损的患者接受了带血管骨移植重建；根据缺损的大小和位置，21例患者接受了DCIA皮瓣，15例患者接受了游离腓骨复合皮瓣。使用数字化全景X线片评估骨吸收情况。在骨重建后、术后6个月、种植手术前以及假体加载时拍摄X线片。
平均观察期6个月后，髂嵴组（DCIA）患者的垂直骨吸收为6.79%，11个月后为10.20%，17个月后为12.58%。腓骨移植在平均观察时间6个月后骨吸收为5.30%，11个月后为8.26%，17个月后为16.95%。18例患者接受了71颗种植体用于种植体支持的牙修复。
微血管吻合骨移植是下颌骨大缺损重建的可靠治疗选择，在愈合早期移植骨吸收低。此外，所比较的移植骨提供了足够的骨量以允许进行种植修复。
