血管化腓骨重建下颌骨后用腓骨残端游离移植及牙种植的可行性研究

目的: 探讨利用残余腓骨增加下颌骨缺损腓骨重建患者垂直骨高度的临床效果。方法: 选择12例下颌骨缺损血管化腓骨重建后拟行种植牙修复的患者,利用腿部残余腓骨段进行垂直骨增量,同期或延期植入种植体并最终完成牙列修复,对术后骨吸收情况和种植体稳定性、存留率等数据采用SPSS 19.0软件包进行统计分析。结果: 术后6个月,近中骨块和远中骨块的吸收量分别为（0.94±0.18）mm和（0.89±0.15）mm;术后12个月,吸收量分别为（1.16±0.21）mm和（1.07±0.17）mm。种植体植入6个月和12个月后,ISQ值分别为（67.25±6.43）和（71.08±4.89）;边缘骨吸收量在植入术后6个月和12个月分别为（0.65±0.12）mm和（0.76±0.18）mm。术后1年种植体存留率为87.1%。结论: 非血管化腓骨具有可靠的抗吸收能力,在下颌骨缺损重建术后垂直骨高度不足的情况下,可为种植体植入提供充足骨量,并维持长期稳定性和存留率。

The feasibility of fibular free graft and dental implant after reconstruction of mandible with vascularized fibula flap

PURPOSE: To investigate the effect of increasing vertical bone height for patients of mandible defects reconstructed with vascular fibular flap. METHODS: A total of 12 patients with mandibular defects were selected who wanted to receive dental implantation repairment after vascularized fibular reconstruction. Vertical bone augmentation was performed using the residual fibula segment, and dental implants were implanted in the same stage or second stage, and finally the dentures retained with implants were completed. Postoperative bone level, implant stability and survival rate were statistically analyzed using SPSS 19.0 software package. RESULTS: The bone loss of segment A and B were (0.94±0.18) mm and (0.89±0.15) mm 6 months after surgery, and (1.16±0.21) mm and (1.07±0.17) mm 12 months after surgery, respectively. ISQ values were (67.25±6.43) and (71.08±4.89) 6 and 12 months after implant implantation, respectively. Marginal bone level was (0.65±0.12) mm and (0.76±0.18) mm 6 and 12 months after implantation, respectively. The implant survival rate was 87.1% 1 year after surgery. CONCLUSIONS: Non-vascularized fibula has reliable anti-absorptive capacity, which can provide sufficient bone mass for implant implantation and maintain its long-term stability and survival rate in cases of insufficient vertical bone height after mandibular reconstruction.