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目的 :总结折叠腓骨肌皮瓣即刻种植延期修复下颌骨缺损的优缺点,并观察其临床疗效。方法 :收集2001年1月—2012年12月南京医科大学附属口腔医院颌面外科采用折叠腓骨肌皮瓣同期牙种植修复下颌骨缺损的患者8例。根据缺损的部位和特点,设计折叠成“双管”型腓骨肌皮瓣修复术区缺损,即刻植入22枚牙种植体。6~12个月后行种植体上部修复。结果:8例腓骨肌皮瓣7例成活(成活率87.50%),1例术后坏死取出腓骨瓣。19枚种植体义齿修复后2年内功能发挥良好(2年存留率86.36%)。术后X线片示重建下颌骨高度满意,腓骨肌瓣与健侧下颌骨骨断端愈合良好,种植体发生骨愈合。术后随访平均2~5年,无严重并发症,种植牙功能良好,腓骨肌瓣重建下颌骨外形满意。结论:折叠腓骨肌皮瓣结合牙种植修复下颌骨缺损最终可以获得满意的外形和功能,技术条件允许时可以选择使用。
OBJECTIVE: To summarize the advantages and disadvantages of immediate reconstruction of mandibular defects with folded fibula myocutaneous flap and to observe its clinical efficacy. Methods: From January 2001 to December 2012, 8 cases of mandibular defects were repaired in the maxillofacial surgery department of Stomatology Hospital of Nanjing Medical University. According to the site and characteristics of the defect, the design was folded into “double tube” type fibular myocutaneous flap to repair the defect in the operation area, and 22 dental implants were implanted immediately. 6 to 12 months after the implant upper repair. Results: Seven cases of fibular myocutaneous flap survived (87.50% survival rate) and one case of fibula flap was removed after necrosis. 19 implant denture function within 2 years after repair (2-year survival rate of 86.36%). The postoperative X-ray showed satisfactory height reconstruction of the mandible, the fibula flap and the contralateral mandibular bone of the healthy side healed well, and the implant healed. The patients were followed up for an average of 2 to 5 years. There was no serious complication, and the dental implants were good. The mandibular shape was reconstructed with fibula flap reconstruction. CONCLUSIONS: Folding fibular myocutaneous flaps combined with dental implants in the treatment of mandibular defects can ultimately achieve satisfactory shape and function, with the option of using them when technical conditions permit.