Li Li, He Qian, Zhou Na, Zhang Zhaoxia, Lv Xiaoming, Zhang Jie
Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, No. 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, China.
Sci Rep. 2025 Aug 2;15(1):28224. doi: 10.1038/s41598-025-13774-x.
Vascularised iliac flaps (VIFs) are widely used for the reconstruction of jawbone defects; however, postoperative donor-site complications, such as gait disturbances, with an incidence of 13.9-50%, significantly impede patient recovery. Despite this, evidence-based rehabilitation protocols specific to VIFs remain lacking. Existing rehabilitation guidelines for hip surgeries are unsuitable owing to differences in surgical mechanisms. This study employed the Delphi method, engaging 20 multidisciplinary experts (oral and maxillofacial surgery: 5; orthopaedics: 7; rehabilitation: 6; nursing: 2). Through three rounds of anonymous consultations, and by integrating literature evidence with postoperative mobility assessments, we developed a phased, individualised progressive functional training (PFT) protocol featuring dynamic evaluation, coordinated activation of abdominal and hip muscle groups, and safe exercise strategies during head and neck immobilisation, while overcoming conventional hip rehabilitation limitations (e.g., restrictions on flexion < 90°, and bans on squatting or cross-legged sitting). PFT is structured into six progressive phases, with exercise intensity tailored to assessment outcomes. A single-centre randomised controlled trial (n = 62) demonstrated that PFT significantly accelerated lower limb functional recovery, improved hip mobility and balance, reduced donor-site pain, and enhanced quality of life (University of Washington Quality of Life questionnaire: F (1,60) = 17.262, P < 0.001), without increasing the risk of flap vascular compromise or iliac hematoma. The limitations of the study include the single-centre design and lack of cross-cultural validation. Future multicentre studies are required to enhance adaptability. This study establishes a foundational yet effective framework for post-VIF rehabilitation, guiding clinical practice and research advancements.
血管化髂骨瓣（VIFs）广泛用于颌骨缺损的重建；然而，术后供区并发症，如步态障碍，发生率为13.9%-50%，严重阻碍患者康复。尽管如此，针对VIFs的循证康复方案仍然缺乏。由于手术机制不同，现有的髋关节手术康复指南并不适用。本研究采用德尔菲法，邀请了20位多学科专家（口腔颌面外科：5位；骨科：7位；康复科：6位；护理：2位）。通过三轮匿名咨询，并将文献证据与术后活动能力评估相结合，我们制定了一个分阶段、个性化的渐进性功能训练（PFT）方案，其特点是动态评估、腹部和髋部肌肉群的协同激活，以及在头颈部固定期间的安全运动策略，同时克服了传统髋关节康复的局限性（如屈曲限制<90°，禁止深蹲或盘腿坐）。PFT分为六个渐进阶段，运动强度根据评估结果进行调整。一项单中心随机对照试验（n = 62）表明，PFT显著加速了下肢功能恢复，改善了髋关节活动度和平衡，减轻了供区疼痛，并提高了生活质量（华盛顿大学生活质量问卷：F(1,60)=17.262，P<0.001），且未增加皮瓣血管受损或髂骨血肿的风险。本研究的局限性包括单中心设计和缺乏跨文化验证。未来需要进行多中心研究以提高适应性。本研究为VIF术后康复建立了一个基础但有效的框架，指导临床实践和研究进展。
