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北京大学学报（医学版） ›› 2024, Vol. 56 ›› Issue (1): 66-73. doi: 10.19723/j.issn.1671-167X.2024.01.011

• 论著 • 上一篇    下一篇

游离腓骨瓣修复下颌骨缺损术后义齿修复的临床分析

王聪伟,高敏,于尧,章文博,彭歆*()   

  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，北京 100081
  • 收稿日期:2023-10-08 出版日期:2024-02-18 发布日期:2024-02-06
  • 通讯作者: 彭歆 E-mail:pxpengxin@263.net

Clinical analysis of denture rehabilitation after mandibular fibula free-flap reconstruction

Congwei WANG,Min GAO,Yao YU,Wenbo ZHANG,Xin PENG*()   

  1. Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of 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, Beijing 100081, China
  • Received:2023-10-08 Online:2024-02-18 Published:2024-02-06
  • Contact: Xin PENG E-mail:pxpengxin@263.net

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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

图1

患者男，29岁，成釉细胞瘤+折叠腓骨瓣修复，采用种植体支持固定义齿，功能评分48.54分"

图2

患者女，18岁，结节性硬化病，数字化腓骨移植+髂骨高嵌体植骨术，采用种植覆盖义齿修复，功能评分46.66分"

图3

指标要素判断矩阵"

表1

各指标最终权重"

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

表2

探索性因子分析结果"

Items Characteristic root Explanation rate of variance after rotation
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

表3

病变性质与义齿修复情况相关性的Pearson卡方检验结果"

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

表4

髁突累及与义齿修复情况相关性的Pearson卡方检验结果"

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

表5

髁突累及情况的功能评价单因素方差分析"

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

表6

义齿修复类型的功能评价单因素方差分析"

Items Sample size Function scores t P Mean difference Cohen’s d
Mean Standard deviation
Implant denture 12 43.482 5.934 4.741 < 0.001 16.359 1.865
Removable denture 14 27.123 10.595
Total 26 34.673 11.960

表7

下颌骨缺损位置的功能评价单因素方差分析"

Items Sample size Function scores t P Mean difference Cohen’s d
Mean Standard deviation
Without involvement of anterior teeth area 14 30.442 13.430 -2.073 0.049 9.167 0.815
With involvement of anterior teeth area 12 39.609 7.909
Total 26 34.673 11.960
1 Wallace CG , Chang YM , Tsai CY , et al. Harnessing the potential of the free fibula osteoseptocutaneous flap in mandible reconstruction[J]. Plast Reconstr Surg, 2010, 125 (1): 305- 314.
doi: 10.1097/PRS.0b013e3181c2bb9d
2 Iizuka T , Häfliger J , Seto I , et al. Oral rehabilitation after mandibular reconstruction using an osteocutaneous fibula free flap with endosseous implants. Factors affecting the functional outcome in patients with oral cancer[J]. Clin Oral Implants Res, 2005, 16 (1): 69- 79.
doi: 10.1111/j.1600-0501.2004.01076.x
3 Parbo N , Murra NT , Andersen K , et al. Outcome of partial mandibular reconstruction with fibula grafts and implant-supported prostheses[J]. Int J Oral Maxillofac Surg, 2013, 42 (11): 1403- 1408.
doi: 10.1016/j.ijom.2013.05.007
4 Lilly GL , Petrisor D , Wax MK . Mandibular rehabilitation: From the Andy Gump deformity to jaw-in-a-day[J]. Laryngoscope Investig Otolaryngol, 2021, 6 (4): 708- 720.
doi: 10.1002/lio2.595
5 Petrovic I , Ahmed ZU , Huryn JM , et al. Oral rehabilitation for patients with marginal and segmental mandibulectomy: A retrospective review of 111 mandibular resection prostheses[J]. J Prosthet Dent, 2019, 122 (1): 82- 87.
doi: 10.1016/j.prosdent.2018.09.020
6 Brown JS , Barry C , Ho M , et al. A new classification for mandi-bular defects after oncological resection[J]. Lancet Oncol, 2016, 17 (1): e23- e30.
doi: 10.1016/S1470-2045(15)00310-1
7 Jacobsen HC , Wahnschaff F , Trenkle T , et al. Oral rehabilitation with dental implants and quality of life following mandibular reconstruction with free fibular flap[J]. Clin Oral Investig, 2016, 20 (1): 187- 192.
doi: 10.1007/s00784-015-1487-3
8 Bodard AG , Salino S , Desoutter A , et al. Assessment of functio-nal improvement with implant-supported prosthetic rehabilitation after mandibular reconstruction with a microvascular free fibula flap: A study of 25 patients[J]. J Prosthet Dent, 2015, 113 (2): 140- 145.
doi: 10.1016/j.prosdent.2014.08.005
9 Patel SY , Kim DD , Ghali GE . Maxillofacial reconstruction using vascularized fibula free flaps and endosseous implants[J]. Oral Maxillofac Surg Clin North Am, 2019, 31 (2): 259- 284.
doi: 10.1016/j.coms.2018.12.005
10 Li R , Meng Z , Zhang Y , et al. Soft tissue management: A critical part of implant rehabilitation after vascularized free-flap reconstruction[J]. J Oral Maxillofac Surg, 2021, 79 (3): 560- 574.
doi: 10.1016/j.joms.2020.11.006
11 Smith Nobrega A , Santiago JF Jr , de Faria Almeida DA , et al. Irradiated patients and survival rate of dental implants: A systematic review and meta-analysis[J]. J Prosthet Dent, 2016, 116 (6): 858- 866.
doi: 10.1016/j.prosdent.2016.04.025
12 Schiegnitz E , Reinicke K , Sagheb K , et al. Dental implants in patients with head and neck cancer: A systematic review and meta-analysis of the influence of radiotherapy on implant survival[J]. Clin Oral Implants Res, 2022, 33 (10): 967- 999.
doi: 10.1111/clr.13976
13 Lee ZH , Avraham T , Monaco C , et al. Optimizing functional outcomes in mandibular condyle reconstruction with the free fibula flap using computer-aided design and manufacturing technology[J]. J Oral Maxillofac Surg, 2018, 76 (5): 1098- 1106.
doi: 10.1016/j.joms.2017.11.008
14 González-García R , Naval-Gías L , Rodríguez-Campo FJ , et al. Vascularized fibular flap for reconstruction of the condyle after mandibular ablation[J]. J Oral Maxillofac Surg, 2008, 66 (6): 1133- 1137.
doi: 10.1016/j.joms.2007.06.680
15 Powers DB , Breeze J , Erdmann D . Vascularized fibula TMJ reconstruction: A report of five cases featuring computerized patient-specific surgical planning[J]. Plast Reconstr Surg Glob Open, 2022, 10 (8): e4465.
doi: 10.1097/GOX.0000000000004465
16 Yu Y , Zhang WB , Liu XJ , et al. Three-dimensional accuracy of virtual planning and surgical navigation for mandibular reconstruction with free fibula flap[J]. J Oral Maxillofac Surg, 2016, 74 (7): 1503.e1- e10.
doi: 10.1016/j.joms.2016.02.020
17 Smolka K , Kraehenbuehl M , Eggensperger N , et al. Fibula free flap reconstruction of the mandible in cancer patients: Evaluation of a combined surgical and prosthodontic treatment concept[J]. Oral Oncol, 2008, 44 (6): 571- 581.
doi: 10.1016/j.oraloncology.2007.07.005
18 Brauner E , Valentini V , Jamshir S , et al. Retrospective review of 78 rehabilitated head and neck postoncological patients: A new classification method[J]. Minerva Stomatol, 2016, 65 (1): 17- 32.
19 Roumanas ED , Garrett N , Blackwell KE , et al. Masticatory and swallowing threshold performances with conventional and implant-supoprted prostheses after mandibular fibula free-flap reconstruction[J]. J Prosthet Dent, 2006, 96 (4): 289- 297.
doi: 10.1016/j.prosdent.2006.08.015
20 Lodders JN , van Baar GJC , Vergeer MR , et al. Implant-based dental rehabilitation in head and neck cancer patients after maxillofacial reconstruction with a free vascularized fibula flap: The effect on health-related quality of life[J]. Support Care Cancer, 2022, 30 (6): 5411- 5420.
doi: 10.1007/s00520-022-06944-4
21 Sozzi D , Novelli G , Silva R , et al. Implant rehabilitation in fibula-free flap reconstruction: A retrospective study of cases at 1-18 years following surgery[J]. J Craniomaxillofac Surg, 2017, 45 (10): 1655- 1661.
doi: 10.1016/j.jcms.2017.06.021
22 Pellegrino G , Tarsitano A , Ferri A , et al. Long-term results of osseointegrated implant-based dental rehabilitation in oncology patients reconstructed with a fibula free flap[J]. Clin Implant Dent Relat Res, 2018, 20 (5): 852- 859.
doi: 10.1111/cid.12658
23 Ali R , Al-Khayatt A , Barclay C . The use of dental implants, cast bars and sleeve overdentures in oral cancer patients[J]. Br Dent J, 2018, 224 (8): 611- 619.
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