Schlieve Thomas, Hull William, Miloro Michael, Kolokythas Antonia
Clinical Assistant Professor, Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, Chicago, IL.
Chief Resident, Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, Chicago, IL.
J Oral Maxillofac Surg. 2015 Mar;73(3):541-9. doi: 10.1016/j.joms.2014.10.019. Epub 2014 Oct 31.
The purpose of this study was to address the following clinical question: Is immediate reconstruction of the mandible with a nonvascularized bone graft after resection of benign pathology a viable treatment option? Another purpose was to determine whether any variables affect the success of this treatment approach.
The authors implemented a retrospective cohort study from a sample of patients diagnosed with a benign tumor of the mandible who were treated with segmental resection and primary reconstruction with an autogenous nonvascularized bone graft. The predictor variables were age, gender, lesion size, and diagnosis, and the outcome variable was graft success determined by re-establishment of mandibular continuity with sufficient bone for implant placement. The χ(2) test was used for statistical analysis of the categorical data and P values less than .05 were considered statistically significant.
Twenty patients with benign mandibular tumors were treated with transoral resection and immediate reconstruction with nonvascularized bone grafts. The mean age was 28.3 years (range, 9 to 63 yr) and 55% (11 of 20) were men. The most common lesion type was ameloblastoma (13 of 20) and all patients underwent reconstruction with autogenous anterior iliac crest bone grafting. Ninety percent of patients (18 of 20) had successful reconstruction. Ten patients underwent successful implant placement and restoration.
Using careful patient selection, treatment of benign pathology with transoral resection and immediate reconstruction with a nonvascularized bone graft from the anterior iliac crest can be successful. In addition, the total treatment time from implant restoration to return to preoperative function is minimized. Therefore, this method of treatment is a viable treatment option and an alternative to delayed reconstruction or reconstruction with vascularized bone flaps.
本研究旨在解决以下临床问题：良性病变切除后立即用非血管化骨移植重建下颌骨是否是一种可行的治疗选择？另一个目的是确定是否有任何变量会影响这种治疗方法的成功率。
作者对一组被诊断为下颌骨良性肿瘤并接受节段性切除及自体非血管化骨移植一期重建的患者进行了回顾性队列研究。预测变量为年龄、性别、病变大小和诊断结果，结果变量为移植成功与否，通过下颌骨连续性重建且有足够的骨量用于种植体植入来确定。采用χ²检验对分类数据进行统计分析，P值小于0.05被认为具有统计学意义。
20例下颌骨良性肿瘤患者接受了经口切除及非血管化骨移植立即重建。平均年龄为28.3岁（范围9至63岁），55%（20例中的11例）为男性。最常见的病变类型是成釉细胞瘤（20例中的13例），所有患者均接受了自体髂嵴骨移植重建手术。90%的患者（20例中的18例）重建成功。10例患者成功植入种植体并完成修复。
通过仔细选择患者，经口切除良性病变并立即用自体髂嵴非血管化骨移植进行重建可以取得成功。此外，从种植体修复到恢复术前功能的总治疗时间最短。因此，这种治疗方法是一种可行的治疗选择，也是延迟重建或血管化骨瓣重建的替代方法。
