Ishikawa Kosuke, Yamamoto Yuhei, Furukawa Hiroshi, Ohiro Yoichi, Satoh Akira, Hayashi Toshihiko
Fellow, Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
Professor, Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
J Oral Maxillofac Surg. 2017 Dec;75(12):2682-2688. doi: 10.1016/j.joms.2017.05.011. Epub 2017 May 24.
This study evaluated short-term and long-term changes in bone height after mandibular reconstruction using an osteotomized fibula graft, with the aim of identifying factors associated with atrophy of the graft in an elderly population.
This retrospective study involved patients who underwent mandibular reconstruction using a free vascularized fibula graft from 2005 through 2015 and had at least 12 months of follow-up. Postoperative panoramic radiographs were used to measure bone height at standardized locations on each segment of the graft at 1 year postoperatively and at later follow-up.
The sample was composed of 30 patients (15 men, 15 women; mean age, 62.6 years; age range, 50 to 80 years). According to the HCL classification (H, hemimandibular segment including the condyle; C, central segment including both mandibular canine teeth; L, lateral segment without the condyle), mandibular defect types were L (n = 19), LC (n = 7), LCL (n = 3), and H (n = 1). There were 0 to 3 segmental osteotomies with the fibula graft. None of the patients received an osseointegrated dental implant during a mean follow-up of 4.0 years (range, 1.5 to 9.7 yr). All patients underwent reconstruction of the mandibular body, 10 of whom also underwent reconstruction of the mandibular ramus. Atrophy of the fibula graft was observed in 9.9 and 15.0% of the body segment and 5.9 and 6.6% of the ramal segment at 1 year postoperatively and at later follow-up, respectively. Graft hypertrophy occurred in the ramal segment in 2 patients. Multivariate analysis showed a significantly higher rate of graft atrophy in women than in men at later follow-up (P = .033).
Fibula grafts showed long-term stability, and in 2 cases even a gain in bone height, in this elderly population. Female gender was identified as a risk factor for atrophy of the fibula bone graft in the body segment of the reconstructed mandible.
本研究评估了采用截骨腓骨移植进行下颌骨重建后骨高度的短期和长期变化，旨在确定老年人群中与移植骨萎缩相关的因素。
本回顾性研究纳入了2005年至2015年间接受游离血管化腓骨移植进行下颌骨重建且随访至少12个月的患者。术后全景X线片用于在术后1年及后续随访时测量移植骨各节段标准化位置的骨高度。
样本包括30例患者（15例男性，15例女性；平均年龄62.6岁；年龄范围50至80岁）。根据HCL分类（H，包括髁突的半下颌节段；C，包括双侧下颌尖牙的中央节段；L，不包括髁突的外侧节段），下颌骨缺损类型为L型（n = 19）、LC型（n = 7）、LCL型（n = 3）和H型（n = 1）。腓骨移植进行了0至3次节段截骨。在平均4.0年（范围1.5至9.7年）的随访期间，没有患者接受骨结合牙种植体。所有患者均进行了下颌体重建，其中10例还进行了下颌支重建。术后1年及后续随访时，腓骨移植体萎缩分别在体部节段的9.9%和15.0%以及支段的5.9%和6.6%中观察到。2例患者的支段出现移植体肥大。多因素分析显示，在后续随访中，女性移植体萎缩率显著高于男性（P = 0.033）。
在该老年人群中，腓骨移植显示出长期稳定性，有2例甚至骨高度增加。女性被确定为重建下颌骨体部节段腓骨骨移植萎缩的危险因素。
