Rehman Umar, Shemie Melissa, Sarwar Mohammad Sohaib, Adebayo Oluwasemilore, Brennan Peter A
Department of Plastic Surgery, Chelsea and Westminster Hospital, London, UK.
Department of Oral and Maxillofacial Surgery, Northwick Park Hospital, London, UK.
Craniomaxillofac Trauma Reconstr. 2024 Jun;17(2):160-168. doi: 10.1177/19433875231198947. Epub 2023 Aug 29.
Systematic Review and Meta-Analysis.
There has been an increasing trend in maxillofacial injuries associated with combat trauma. Within the maxillofacial complex, the mandible is the most likely structure to be damaged during combat. The structural deficits as a result can be reconstructed with many options. These include vascularised bone grafts (VBGs), non-vascularised bone grafts (NVBGs), alloplastic implants, reconstruction bars and distraction osteogenesis. This study aimed to determine the common modality and efficacy of mandibular reconstruction in combat trauma-related defects.
A literature search was conducted on Pubmed, Prospero, Dynamed, DARE, EMBASE, COCHRANE and BMJ databases.
A total of six articles met the inclusion criteria identifying 165 patients requiring mandibular reconstruction. Non-vascularised iliac bone graft (n = 137) was the most common method followed by ileac crest bone chips harvest using Dacron urethran osteomesh tray (n = 24) and frontoparietal grafts (n = 4). Meta-analysis of five out of six trials demonstrated an overall success rate of 85% (95% CI 79-90; I = 59%). A total of 13% (n = 22) of reconstructions failed either completely or partially and 21% (n = 34) of patients suffered postoperative complications.
NVBGs are a practical, cost-effective and favourable method of war zone management of mandibular defects with success rates comparable to those reported in the civilian literature. However, general trauma principles take precedence to rule out life-threatening injuries. Due consideration of patient factors, surgical factors, and available resources are required in the first-line management of combat-related mandibular defects.
系统评价与荟萃分析。
与战斗创伤相关的颌面损伤呈上升趋势。在颌面复合体中,下颌骨是战斗中最易受损的结构。由此产生的结构缺损可有多种重建选择。这些包括带血管骨移植(VBG)、非带血管骨移植(NVBG)、异体植入物、重建杆和牵张成骨。本研究旨在确定战斗创伤相关下颌骨缺损重建的常用方式及疗效。
在PubMed、Prospero、Dynamed、DARE、EMBASE、Cochrane和BMJ数据库中进行文献检索。
共有6篇文章符合纳入标准,确定了165例需要下颌骨重建的患者。非带血管髂骨移植(n = 137)是最常用的方法,其次是使用涤纶尿道骨网托盘采集髂嵴骨碎片(n = 24)和额顶骨移植(n = 4)。六项试验中的五项进行荟萃分析显示总体成功率为85%(95%CI 79 - 90;I² = 59%)。共有13%(n = 22)的重建完全或部分失败,21%(n = 34)的患者出现术后并发症。
非带血管骨移植是战区下颌骨缺损管理的一种实用、经济有效且良好的方法,成功率与平民文献报道相当。然而,一般创伤原则优先以排除危及生命的损伤。在与战斗相关的下颌骨缺损的一线管理中,需要充分考虑患者因素、手术因素和可用资源。