Futran N D, Urken M L, Buchbinder D, Moscoso J F, Biller H F
Division of Otolaryngology, University of South Florida, Tampa.
Arch Otolaryngol Head Neck Surg. 1995 Jan;121(1):70-6. doi: 10.1001/archotol.1995.01890010056010.
To evaluate the nature of complications and complication rates with the use of three different reconstruction plates for the rigid fixation of vascularized bone grafts in oromandibular reconstruction.
We conducted a case series of 95 patients over a 6-year period, with a minimum follow-up of 6 months and a maximum follow-up of 66 months.
Academic tertiary referral medical center.
Forty-eight patients had vascularized bone grafts fixated to native mandible with AO stainless steel reconstruction plates; 25 patients, with AO titanium plates; and 22 patients, with titanium hollow screw reconstruction plates (THORPs). Types of vascularized flaps, mandibular defects to be reconstructed, and use of radiation therapy were similar among the three groups.
The surgical approach involved oromandibular reconstruction with a vascularized bone graft rigidly fixated with a reconstruction plate.
Clinically and radiographically noted complications and resultant treatment.
In the grafts fixated with AO stainless steel reconstruction plates, three plate fractures, seven instances of loose screws, eight plate exposures, and two cases of nonunion occurred. No cases of plate fracture or nonunion occurred in the titanium or THORP groups. One titanium plate and two THORPs were exposed during the study period. One instance of loose screws occurred in the titanium group; none in the THORP group. Seventy-four percent of those complications occurred within 12.4 months (the mean follow-up time of the THORP group). The incidence of complications in the stainless steel group was significantly greater than that in the titanium or THORP groups. No statistically significant increase in the rate of complications was noted when radiation therapy was used as a component of treatment.
To our knowledge, this is the first study to compare three different reconstruction plates for fixation in vascularized bone reconstruction of the mandible. AO THORPs are now used almost exclusively to rigidly fixate vascularized bone grafts because of their advanced design and their potential for osseointegration and because fewer screws are necessary to attain adequate fixation than with conventional AO reconstruction plates.
评估在口腔颌面部重建中使用三种不同重建钢板对带血管骨移植进行坚固内固定时并发症的性质及发生率。
我们对95例患者进行了为期6年的病例系列研究，随访时间最短6个月，最长66个月。
学术性三级转诊医疗中心。
48例患者使用AO不锈钢重建钢板将带血管骨移植固定于下颌骨；25例患者使用AO钛板；22例患者使用钛空心螺钉重建钢板（THORP）。三组患者的带血管皮瓣类型、需重建下颌骨缺损情况及放疗使用情况相似。
手术方法为采用带血管骨移植并用重建钢板进行坚固内固定的口腔颌面部重建。
临床及影像学记录的并发症及相应治疗情况。
在使用AO不锈钢重建钢板固定的移植骨中，发生了3例钢板骨折、7例螺钉松动、8例钢板外露和2例骨不连。钛板组和THORP组未发生钢板骨折或骨不连病例。在研究期间，1例钛板和2例THORP发生外露。钛板组发生1例螺钉松动；THORP组未发生。74%的并发症发生在12.4个月内（THORP组的平均随访时间）。不锈钢组的并发症发生率显著高于钛板组或THORP组。当放疗作为治疗的一部分时，并发症发生率无统计学意义的增加。
据我们所知，这是第一项比较三种不同重建钢板用于下颌骨带血管骨重建固定的研究。由于其先进的设计、骨整合潜力以及与传统AO重建钢板相比实现充分固定所需螺钉较少，AO THORP目前几乎专门用于坚固固定带血管骨移植。
