Nicholson R E, Schuller D E, Forrest L A, Mountain R E, Ali T, Young D
Department of Otolaryngology, Arthur G. James Cancer Hospital, Columbus, USA.
Arch Otolaryngol Head Neck Surg. 1997 Feb;123(2):217-22. doi: 10.1001/archotol.1997.01900020107016.
To evaluate and to compare rates and timing of exposure of alloplastic mandibular plates by plate type and tissue reconstruction technique.
A retrospective review series of 92 consecutive patients for 4 years (mean follow-up, 30 months).
National Cancer Institute-designated comprehensive cancer center in a freestanding cancer hospital.
Seventy-nine patients received alloplastic mandibular plates for segmental defects, and 13 patients received compression plates for mandibular osteotomies following ablative cancer surgery, including 21 titanium hollow osseointegrating reconstruction, 41 Storz, 16 Synthes, and 5 AO/ASIF (Arbeitsgemein schott fur Ostcosynthese fragen/Association for the Study of Internal Fixation) plates. Primary flap repair was provided by 71 pedicled soft tissue and 19 osseocutaneous free flaps, with primary closure in the remaining 2.
Most of the reconstructions of the mandibular defect was with an alloplastic plate with musculocutaneous flap or revascularized bone graft.
Clinically apparent intraoral or extraoral plate exposure.
Plate exposure occurred in 25 cases. Nine plates were exposed extraorally, at a mean postoperative interval of 40 weeks. The remaining 16 plates were exposed intraorally at a mean postoperative interval of 16 weeks. There was no significant difference in the exposure rates of different plate types or methods of reconstruction. The titanium hollow osseointegrating reconstruction plate had a similar exposure rate compared with the other plates. Size and site of the defect were the only significant predictors of plate exposure Radiotherapy and postoperative complications did not affect the rate of exposure.
Extraoral plate exposure occurs less commonly and later in the postoperative period than intraoral exposure, suggesting different causes. Plate type and type of flap reconstruction do not affect the rate of exposure. This may reflect long follow-up.
根据接骨板类型和组织重建技术评估并比较异体下颌骨接骨板的暴露率及暴露时间。
对92例连续患者进行为期4年的回顾性系列研究（平均随访30个月）。
一家独立癌症医院中由国家癌症研究所指定的综合癌症中心。
79例患者接受异体下颌骨接骨板修复节段性缺损，13例患者在癌症切除术后接受下颌骨截骨术的加压接骨板，其中包括21块钛质中空骨整合重建接骨板、41块史托斯接骨板、16块辛迪斯接骨板和5块AO/ASIF（骨科学合成问题研究协会/内固定研究协会）接骨板。71例采用带蒂软组织瓣和19例采用骨皮游离瓣进行一期皮瓣修复，其余2例进行一期缝合。
大多数下颌骨缺损的重建采用异体接骨板联合肌皮瓣或带血运骨移植。
临床上明显的口内或口外接骨板暴露。
25例发生接骨板暴露。9块接骨板口外暴露，术后平均间隔40周。其余16块接骨板口内暴露，术后平均间隔16周。不同接骨板类型或重建方法的暴露率无显著差异。钛质中空骨整合重建接骨板与其他接骨板的暴露率相似。缺损大小和部位是接骨板暴露的唯一显著预测因素。放疗和术后并发症不影响暴露率。
口外接骨板暴露比口内暴露在术后更少见且更晚发生，提示原因不同。接骨板类型和皮瓣重建类型不影响暴露率。这可能反映了长期随访的结果。
