血管化腓骨瓣修复涉及髁突下颌骨缺损的临床应用

目的:对累及髁突的不同类型下颌骨缺损采用游离腓骨瓣修复的方法、经验进行总结。方法:2001年10月-2004年10月,53例累及下颌升支上部的颌骨良性病损,行下颌骨切除后采用游离腓骨瓣进行下颌骨重建,分别采用了腓骨代替髁突法(30例)、游离髁突法(7例)及保留髁突法(16例)3种方法进行下颌骨缺损修复重建。分析总结临床方法经验,并对患者术后外形和功能进行临床评价。结果:本组血管化游离腓骨瓣移植成活率98.1%(52/53);41例患者术后随访,进行了临床检查及外形、功能评价,经Fisher检验,腓骨替代髁突组、游离髁突组及保留髁突组患者在术后外形和进食、语音功能上无显著差别。结论:3种不同髁突处理方法进行游离腓骨瓣下颌骨缺损重建,在临床上实用可行,可依据患者病损的具体情况选用。

Clinical Application of Free Fibula Flap in Reconstruction of Different Mandible Defects

Objective: To review 3 methods of condyle management in mandible reconstruction with free fibula flap and evaluate their clinical effect. Methods: From October 2001 to October 2004, mandibular defcts of 53 cases of benign mandible disease, which involved superior ramus after mandibulectomy, were reconstructed with free fibula flap in three methods respectively. Method one was fibula substitute condyle method (30 cases), which was placement of the distal end of the fibula flap into the glenoid fossa substituted condyle. Method two was condyle graft method (7 cases), which was attachment of the resected condyle as a nonvascularized transplant to the end of the fibula flap. Method three was condyle preservation method (16 cases), which included condyle preservation, and vascularized fibula flap reconstruction. The clinical experiences were summarized, and the post-operation effects were evaluated. Results: The overall survival rate of fibula flap was 98.1%(52/53). 41 patients were followed up, whose post-operation facial appearance and oral function were evaluated, and there were no differences in post-operation facial appearance, oral deglutition and speech among three groups patients. Conclusion: Using different condyle managements in mandible reconstruction with free fibula flap according the patient's individual condition, is feasible and reliable.