Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A.
Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.
Laryngoscope. 2024 Dec;134(12):4929-4934. doi: 10.1002/lary.31640. Epub 2024 Jul 17.
Assess the long-term plate complications with patient-specific plates (PSPs) created with computer-aided design (CAD) and computer-aided manufacturing (CAM) for fibula free flap reconstructions for mandibular defects.
Retrospective chart review from January 2010 to July 2022 of patients who underwent mandibular reconstruction with a fibula free flap and PSP. Primary outcome was plating-related complications, defined as plate exposure, fracture, loose screws, and plate removal.
A total of 221 patients underwent PSP fibula reconstruction. Average age was 59.8 + 14.3 years old with male to female ratio of 2:1. Squamous cell carcinoma of the mandible was the most common reason for resection, 47.5%, n = 105. Plate removal occurred in 11% of patients (n = 25) about 17.4 months after the initial surgery. Plates were removed due to exposure (76%, n = 19) or screw loosening (24%, n = 6). Malignancy was associated with an increased risk of plate complications when compared to benign tumor (odds ratio [OR] 9.04, confidence interval [CI] 1.36-3.85), osteonecrosis (OR 1.38, CI 0.59-3.48), and trauma (OR 1.26, CI 0.23-12.8). Postoperative radiation therapy (OR 2.27, CI 1.07-4.82, p = 0.026) and surgical site infection (OR 9.22, CI 4.11-21.88, p = 0.001) were associated with more plate complications.
CAD creates PSPs that remain stable in the majority of patients over the long term. Plate removal is less compared to non-PSP reconstruction. Consideration of the soft tissue envelope over the plate and management of perioperative infection at the time of surgery should be entertained.
4 Laryngoscope, 134:4929-4934, 2024.
评估使用计算机辅助设计（CAD）和计算机辅助制造（CAM）制作的个体化接骨板（PSP）用于游离腓骨皮瓣重建下颌骨缺损的长期接骨板并发症。
回顾性分析 2010 年 1 月至 2022 年 7 月接受游离腓骨皮瓣和 PSP 下颌骨重建的患者的病历。主要结局是与接骨板相关的并发症，定义为接骨板暴露、骨折、松动螺钉和接骨板取出。
共 221 例患者接受 PSP 腓骨重建。平均年龄为 59.8±14.3 岁，男女比例为 2:1。下颌骨鳞状细胞癌是最常见的切除原因，占 47.5%（n=105）。11%的患者（n=25）在初次手术后约 17.4 个月时行接骨板取出术。接骨板取出的原因分别为暴露（76%，n=19）和螺钉松动（24%，n=6）。与良性肿瘤相比，恶性肿瘤（比值比[OR]9.04，置信区间[CI]1.36-3.85）、骨坏死（OR 1.38，CI 0.59-3.48）和创伤（OR 1.26，CI 0.23-12.8）与接骨板并发症的风险增加相关。术后放疗（OR 2.27，CI 1.07-4.82，p=0.026）和手术部位感染（OR 9.22，CI 4.11-21.88，p=0.001）与更多的接骨板并发症相关。
CAD 制作的 PSP 在大多数患者中能长期保持稳定。与非 PSP 重建相比，接骨板取出率较低。在手术时应考虑到接骨板上方的软组织覆盖情况，并应注意围手术期感染的处理。
4 级，《喉镜》，134:4929-4934，2024 年。
