Ishii Naohiro, Shimizu Yusuke, Ihara Jyun, Kishi Kazuo
Department of Plastic and Reconstructive Surgery, Tochigi Cancer Center, Tochigi, Japan; Department of Plastic and Reconstructive Surgery, University of the Ryukyus Hospital, Okinawa, Japan; and Department of Plastic and Reconstructive Surgery, Keio University, Tokyo, Japan.
Plast Reconstr Surg Glob Open. 2016 Aug 17;4(8):e1018. doi: 10.1097/GOX.0000000000001018. eCollection 2016 Aug.
High-quality mandibular reconstruction using vascularized free fibular graft is necessary to provide an osseointegrated dental implant and fixed denture. An appropriate crown-implant ratio is needed, and a good match between bones is extremely important. There are no articles describing the analysis and evaluation of both the fibula and mandible in the same patients.
Computed tomography images of both mandible and fibula of 80 patients were selected in a random manner. We measured bone height of the fibula and mandible at specified points and evaluated the difference of bone height between the fibula and mandible using fibular single or double-barrel grafts.
The percentage of patients who had a "good" result for a fibular single graft was only 13.8%. There was no significant difference in bone heights when analyzed by gender. Whether patients were dentulous or not had a large influence on the difference between fibular and mandibular bone heights. Most young patients, but only half of older patients, needed fibular double-barrel grafts. Overweight patients with a high body mass index more often needed fibular double-barrel grafts.
For mandibular reconstruction using a fibular graft, preoperative analysis of the patient's profile and proper use of a fibular single or double-barrel graft contribute to minimizing the difference between the height of the grafted fibula and native mandible and are keys to an ideal reconstruction with good cosmetics and function.
使用带血管蒂游离腓骨移植进行高质量的下颌骨重建对于提供骨整合牙种植体和固定义齿是必要的。需要合适的冠种植体比例，并且骨之间的良好匹配极为重要。尚无文章描述对同一患者的腓骨和下颌骨进行分析和评估。
随机选择80例患者的下颌骨和腓骨的计算机断层扫描图像。我们在指定点测量腓骨和下颌骨的骨高度，并使用腓骨单筒或双筒移植评估腓骨和下颌骨之间的骨高度差异。
腓骨单筒移植“良好”结果的患者百分比仅为13.8%。按性别分析时骨高度无显著差异。患者是否有牙对腓骨和下颌骨高度差异有很大影响。大多数年轻患者，但只有一半的老年患者需要腓骨双筒移植。体重指数高的超重患者更常需要腓骨双筒移植。
对于使用腓骨移植进行下颌骨重建，术前对患者情况进行分析并适当使用腓骨单筒或双筒移植有助于最小化移植的腓骨与天然下颌骨高度之间的差异，并且是实现具有良好美观和功能的理想重建的关键。
