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北京大学学报（医学版） ›› 2025, Vol. 57 ›› Issue (1): 78-84. doi: 10.19723/j.issn.1671-167X.2025.01.012

• 论著 • 上一篇    下一篇

即刻种植体支持式义齿修复的血管化髂骨瓣重建下颌骨缺损

康一帆1, 葛严军2, 吕晓鸣1, 谢尚1, 单小峰1,*(), 蔡志刚1,*()   

  1. 1. 北京大学口腔医学院·口腔医院口腔颌面外科，国家口腔医学中心，国家口腔疾病临床医学研究中心，口腔生物材料和数字诊疗装备国家工程研究中心，口腔数字医学北京市重点实验室，国家卫生健康委员会口腔医学计算机应用工程技术研究中心，国家药品监督管理局口腔材料重点实验室，北京 100081
    2. 北京大学口腔医学院·口腔医院修复科，国家口腔医学中心，国家口腔疾病临床医学研究中心，口腔生物材料和数字诊疗装备国家工程研究中心，口腔数字医学北京市重点实验室，国家卫生健康委员会口腔医学计算机应用工程技术研究中心，国家药品监督管理局口腔材料重点实验室，北京 100081
  • 收稿日期:2024-09-25 出版日期:2025-02-18 发布日期:2025-01-25
  • 通讯作者: 单小峰,蔡志刚 E-mail:bdkqsxf@163.com;c2013xs@163.com
  • 基金资助:
    首都卫生发展科研专项(CFH2024-2-4104)

One-stage mandibular reconstruction combining iliac flap with immediate implant-based denture

Yifan KANG1, Yanjun GE2, Xiaoming LV1, Shang XIE1, Xiaofeng SHAN1,*(), Zhigang CAI1,*()   

  1. 1. Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Research Center of Engineering and Technology for Computerized Dentistry & NMPA Key Laboratory for Dental Materials, Beijing 100081, China
    2. Department of Prosthodontic, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Research Center of Engineering and Technology for Computerized Dentistry & NMPA Key Laboratory for Dental Materials, Beijing 100081, China
  • Received:2024-09-25 Online:2025-02-18 Published:2025-01-25
  • Contact: Xiaofeng SHAN, Zhigang CAI E-mail:bdkqsxf@163.com;c2013xs@163.com
  • Supported by:
    Capital' s Funds for Health Improvement and Research(CFH2024-2-4104)

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摘要：

目的: 总结使用即刻种植体支持式义齿修复的血管化髂骨瓣重建下颌骨的临床效果，探讨本方法的可行性及适应证。方法: 回顾2020年6月至2023年8月于北京大学口腔医院行即刻种植体支持式义齿修复的血管化髂骨瓣重建下颌骨的患者10例，患者术前活检病理均确诊为良性肿瘤。通过三维色谱分析评价术后下颌骨重建的精确度，通过测量颈部平台偏差、根尖偏差、颈部平台深度偏差、角度偏差评价术后种植体植入的精确度，通过计算种植体累积生存率及测量术后颈部骨吸收情况评价远期效果。结果: 10例患者共植入38枚种植体，中位随访时间为23.5个月，在随访期内均未出现伤口感染、钛板暴露、钛板折断、种植体松动、种植体折断、基台折断以及义齿折断等术后并发症。术后下颌骨表面偏差≤1 mm的区域占67.82% ±10.16%，≤2 mm的区域占82.14% ±6.58%，≤3 mm的区域占90.61% ±4.62%；平均最大表面偏差为(6.10±0.89) mm，整体平均表面偏差为(1.14±0.31) mm；术后种植体颈部平台偏差为(2.02±0.58) mm，根尖偏差为(2.25±0.66) mm，颈部平台深度偏差为(1.26±0.51) mm，轴向角度偏差为1.84°±1.10°。随访期内有1例患者出现种植体周围炎，4例患者出现种植体周围黏膜炎，种植体存留率为100%，种植体的累积生存率为97.37%，种植体颈部平均骨吸收为0.94 mm。结论: 使用即刻种植体支持式义齿修复的血管化髂骨瓣重建下颌骨在临床实践中切实可行，但仍需要更大样本量的临床研究和更长期的术后随访。

关键词: 下颌骨重建术, 髂骨瓣, 植入物支持义齿, 种植即刻修复, 治疗结果

Abstract:

Objective: To evaluate the clinical outcomes and define the indications for a one-stage mandibular reconstruction technique that combines iliac bone flaps with immediate implant-based dentures, and to assess both the accuracy of surgical planning and the long-term success of the procedure. Methods: A total of ten patients underwent the procedure at Peking University Hospital of Stomatology between June 2020 and August 2023. The preoperative biopsy pathology of all the patients confirmed a benign tumor. In this technique, iliac bone flaps were used for mandibular reconstruction, and immediate implant-based dentures were placed during the same surgical session. Various outcome measures were evaluated, including the accuracy of the surgical reconstruction, implant placement deviations (entry point, apical point, depth, and angle), and long-term outcomes, such as cervical bone resorption, implant survival, and the cumulative survival rate. Results: Thirty-eight implants were successfully inserted into the iliac flaps of the ten patients. The median follow-up duration was 23.5 months, and no significant complications occurred during the follow-up period, such as infections, titanium plate exposure, implant loosening, or damage to the implants and dentures. The accuracy of preoperative virtual surgical planning (VSP) was highly reliable. The repeatability of the VSP model compared to the postoperative reconstructed mandible was as follows: 67.82% ±10.16% within 1 mm, 82.14% ±6.58% within 2 mm, and 90.61% ±4.62% within 3 mm. The average maximum deviation from the plan was (6.10±0.89) mm, with an average overall deviation of (1.14±0.31) mm. For the implants, deviations in critical parameters were as follows: entry point deviation was (2.02±0.58) mm, apical point deviation was (2.25± 0.66) mm, depth deviation was (1.26±0.51) mm, and angular deviation was 1.84°±1.10°. The implant survival rate remained 100% during the follow-up, with a cumulative survival rate of 97.37% from 1 to 4 years. Average cervical bone resorption was 0.94 mm. Conclusion: The combination of iliac bone flaps with immediate implant-based dentures for one-stage mandibular reconstruction demonstrated pro-mising clinical outcomes, including high implant survival and minimal complications. This technique proved to be safe and reliable for mandibular reconstruction. However, further studies with larger sample sizes and longer follow-up periods are necessary to confirm the long-term efficacy and optimal indications for this procedure.

Key words: Mandibular reconstruction, Iliac flaps, Implant-supported dental prosthesis, Immediate implant-based denture, Treatment outcome

中图分类号: 

  • R782.23

图1

术前设计流程"

图2

即刻种植体支持式义齿修复的血管化髂骨瓣重建下颌骨的手术实施流程"

图3

下颌骨重建术后三维色谱分析表面偏差(mm)"

图4

种植体植入精度测量"

图5

某患者术前、术后即刻、术后1年口内像及正面像"

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ISSN 1671-167X
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