游离腓骨瓣修复下颌骨缺损术后义齿修复的临床分析

doi:10.19723/j.issn.1671-167X.2024.01.011

摘要/Abstract

摘要：

目的: 分析游离腓骨瓣重建下颌骨缺损患者术后义齿修复情况，并对义齿功能进行评价。方法: 收集2015年1月至2020年12月期间154例因炎症、外伤、肿瘤等原因实施下颌骨节段切除，并采用血管化游离腓骨瓣修复下颌骨缺损的患者，回顾相关资料并随访调查患者义齿修复的相关情况，同时对义齿修复功能评价的各指标进行专家权威赋值，获得义齿功能评分。采用SPSS 18.0软件对纳入研究患者的基本信息和患者义齿修复情况进行统计分析。结果: 游离腓骨瓣修复下颌骨缺损患者术后义齿修复率为17.5%，其中，下颌骨良性肿瘤患者采用腓骨瓣修复的术后义齿修复率为25.0%(18/72例)，明显高于恶性肿瘤患者的术后义齿修复率11.0%(9/82例，P < 0.05)。缺损累及髁突和不累及髁突的患者在义齿修复率和义齿功能评分上差异均无统计学意义(P>0.05)。种植义齿修复患者的义齿功能评分显著高于活动义齿修复的患者(P < 0.05)。根据Brown分类，缺损累及下颌骨前牙区患者的义齿功能评分显著高于未累及下颌骨前牙区的患者(P < 0.05)。因口内条件差而未行义齿修复的患者约占未行义齿修复患者总数的37.9%，是未行义齿修复的最主要原因。结论: 游离腓骨瓣重建下颌骨缺损的义齿修复情况与肿瘤性质、口内条件等关系密切，种植义齿的临床修复效果更佳，是未来颌骨重建后义齿修复的更优选择。

关键词: 游离组织瓣, 腓骨移植, 下颌骨重建术, 牙种植体

Abstract:

Objective: To evaluate the postoperative denture restoration and denture function in patients with mandibular defect reconstructed with vascularized free fibula flap. Methods: In the study, 154 patients who underwent mandibular segment resection and used vascularized free fibula flap to repair mandibular defects due to inflammation, trauma and tumor from January 2015 to December 2020 were collected. These patients had common inclusion criteria which were stable occlusal relationship before operation, segmental defects of mandibular bone caused by lesions of mandible and adjacent parts (such as floor of mouth, tongue, cheek), free fibula flap used for repair and surviving after operation. Relevant data were reviewed and situation of denture restoration was followed up. A questionnaire related to denture functional evaluation had been proposed for those who had completed the denture rehabilitation. The evaluation index of denture restoration function was assigned by expert authority to obtain the denture function score. SPSS 18.0 software was used for statistical analysis of the basic information of the patients included in the study and the denture restoration of the patients. Results: The rate of postoperative denture restoration in the patients with mandibular defects repaired by free fibula flap was 17.5%, and the rate of postoperative denture restoration in the patients with benign mandibular tumors was 25.0% (18/72), which was significantly greater than that in the patients with malignant tumors 11.0% (9/82, P < 0.05). There was no significant difference in denture function score between the patients with condylar defect and those without condylar defect in denture repair rate and denture function score (P>0.05). The functional score of implant denture was significantly greater than that of removable denture (P < 0.05). According to Brown classification, the denture function score of the patients with the defect invo-lving the anterior mandibular region was significantly greater than that of the patients without the anterior mandibular region involved (P < 0.05). The poor oral conditions, such as less amount of remaining teeth, insufficient retention strength, large mobility of soft tissue in the surgical area, poor oral vestibular groove condition became the main reason of not receiving denture restoration (37.86%). Conclusion: The denture rehabilitation of mandibular defect reconstructed with vascularized free fibula flap is closely rela-ted to pathological properties and oral conditions. The clinical outcome of implant denture has been confirmed effectively and it is a better choice for future denture restoration after mandibular reconstruction.

Key words: Free tissue flaps, Fibula transplantation, Mandibular reconstruction, Dental implants

中图分类号:

R782.2

王聪伟,高敏,于尧,章文博,彭歆. 游离腓骨瓣修复下颌骨缺损术后义齿修复的临床分析[J]. 北京大学学报（医学版）, 2024, 56(1): 66-73.

Congwei WANG,Min GAO,Yao YU,Wenbo ZHANG,Xin PENG. Clinical analysis of denture rehabilitation after mandibular fibula free-flap reconstruction[J]. Journal of Peking University (Health Sciences), 2024, 56(1): 66-73.

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参考文献 23

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Items	Distribution of scores	Weight
Appearance improvement	10, 20, 30, 40, 50	0.059
Denture comfort	10, 20, 30, 40, 50	0.247
Pronunciation	10, 20, 30, 40, 50	0.087
Mastication	10, 30, 50	0.307
Self-evaluation of quality of life	10, 30, 50	0.300

Items	Characteristic root			Explanation rate of variance after rotation
Items	Characteristic root	Variance explanation rate	Cumulative percentage	Characteristic root	Variance explanation rate	Cumulative percentage
Appearance improvement	3.136	62.7	62.7	3.136	62.7	62.7
Denture comfort	0.805	16.1	78.8
Pronunciation	0.610	12.2	91.0
Mastication	0.322	6.4	97.5
Self-evaluation of quality of life	0.127	2.5	100.0

Denture rehabilitation	Nature of disease		Total	χ²	P
Denture rehabilitation	Benign	Malignant	Total	χ²	P
Yes	18	9	27	5.215	0.022
No	54	73	127
Total	72	82	154

Denture rehabilitation	Condylar defect		Total	χ2	P
Denture rehabilitation	Yes	No	Total	χ2	P
Yes	6	21	27	1.221	0.269
No	42	85	127
Total	48	106	154

Items	Sample size	Function scores		t	P	Mean difference	Cohen’s d
Items	Sample size	Mean	Standard deviation	t	P	Mean difference	Cohen’s d
With condylar defect	5	39.318	8.975	0.965	0.344	5.751	0.48
Without condylar defect	21	33.567	12.490	0.965	0.344	5.751	0.48
Total	26	34.673	11.960