北京大学学报(医学版) ›› 2022, Vol. 54 ›› Issue (2): 356-362. doi: 10.19723/j.issn.1671-167X.2022.02.025
LAN Lin,HE Yang(),AN Jin-gang,ZHANG Yi
摘要:
目的: 探讨颧骨缺损不同治疗方法的修复效果及特点。方法: 选择2012年8月至2019年8月于北京大学口腔医院口腔颌面外科就诊的颧骨缺损行修复重建的37例患者。根据颧骨缺损涉及的部位,将缺损分为四类:0类,缺损不涉及颧骨区段结构,仅为厚度(突度)变化;Ⅰ类,单个缺损位于颧骨体部或只涉及一个突起方向的缺损;Ⅱ类,单个缺损累及两个突起方向;Ⅲa类,单个缺损累及三个突起方向以上的缺损;Ⅲb类,颧骨缺损同时累及相应上颌骨的大范围缺损。统计分析各类颧骨缺损的病因、缺损时间、缺损大小及特点、采用的修复重建方式,并随访记录术后并发症等。术后CT评价颧骨突度及对称性恢复效果,进行色谱差值分析评价术后稳定效果。结果: 本组患者中,由创伤引起的颧骨缺损有25例(67.57%),肿瘤切除引起的颧骨缺损有11例(29.73%),另1例为骨发育畸形导致的颧骨缺损。19例患者行单纯自体骨移植修复,6例患者行血管化组织瓣修复,5例患者仅使用外植入物,另外7例患者使用血管化组织瓣联合外植入物修复。导航组和非导航组健、患侧颧骨突度差值中位数分别为0.45 mm(0.20~2.50 mm)和1.60 mm(0.10~2.90 mm),两组差值有统计学意义(P=0.045)。2例使用钛网结合股前外侧皮瓣修复的患者术后钛网发生明显变形或断裂,2例铸造个性化钛修复术后因感染而取出。结论: 对于无明显结构改变的颧骨缺损,可以用自体骨游离移植或异体材料修复。颧骨缺损存在骨支柱破坏、慢性炎症、口鼻腔相通或伴有明显软组织量不足时,建议带蒂颅骨骨膜瓣或血管化骨组织瓣修复。钛网可用于修复大量骨组织缺损的病例,同时建议联合血管化骨组织瓣移植修复。
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