游离腓骨肌-皮-筋膜复合瓣同期修复40例放射性下颌骨坏死术后缺损效果评价

doi:10.19438/j.cjoms.2018.03.016

中国口腔颌面外科杂志 ›› 2018, Vol. 16 ›› Issue (3): 270-274.doi: 10.19438/j.cjoms.2018.03.016

游离腓骨肌-皮-筋膜复合瓣同期修复40例放射性下颌骨坏死术后缺损效果评价

刘军平¹，李群星²，张汉卿²，欧展鹏²，范松²，李劲松²

1.广东医科大学寮步医院口腔科，广东东莞523400；
2.中山大学孙逸仙纪念医院口腔颌面外科，广东广州510120

收稿日期:2017-11-27 修回日期:2018-01-18 出版日期:2018-05-20 发布日期:2018-06-12
通讯作者: 李劲松， E-mail:lijinsong1967@163.com
作者简介:刘军平（1976-），男，副主任医师，E-mail: ljp762@163.com

Efficacy and safety of reconstruction of mandibular defect in 40 patients with osteoradionecrosis of the jaw with free fibular osteomyofascial compound flap

LIU Jun-ping¹, LI Qun-xing², ZHANG Han-qing², OU Zhan-peng², FAN Song², LI Jin-song².

1.Department of Stomatology, Liaobu Hospital of Guangdong Medical University. Dongguan 523400;
2.Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University. Guangzhou 510120, Guangdong Province, China

Received:2017-11-27 Revised:2018-01-18 Online:2018-05-20 Published:2018-06-12

摘要/Abstract

摘要： 目的： 探讨游离腓骨肌-皮-筋膜复合瓣在修复下颌骨放射性骨坏死（osteoradionecrosis of the jaws，ORNJ）术后软、硬组织缺损的应用价值。方法： 选择2014年3月—2017年7月间，中山大学孙逸仙纪念医院口腔颌面外科40例下颌骨 ORNJ患者，所有病例原发肿瘤均为鼻咽癌，排除鼻咽癌复发。以游离腓骨肌-皮-筋膜复合瓣重建放射性下颌骨坏死手术切除后的骨缺损，以皮岛修复皮肤软组织缺损，以筋膜修复口内黏膜缺损并充填软组织缺损的空腔，记录腓骨截骨、组织瓣存活情况，供区、受区并发症，术后开口度和余留牙咬合情况，对颌面部外形和功能进行评价。结果： 随访3～6个月，游离腓骨肌-皮-筋膜复合瓣重建下颌骨缺损均获成功。下颌骨截骨长度5.5～16.0 cm，切取腓骨长度7.5～17.0 cm。无1例发生严重供区或受区并发症，所有病例外形恢复良好，开口度1.0～3.5 cm，余留牙咬合正常。结论： 游离腓骨肌-皮-筋膜复合瓣能很好地即刻重建放射性下颌骨坏死术后颌面部软、硬组织缺损，降低手术并发症，值得临床推广应用。

关键词: 下颌骨, 放射性骨坏死, 腓骨肌-皮-筋膜复合瓣

Abstract: PURPOSE: To explore the clinical efficacy of free fibular osteomyofascial compound flap in mandibular defect reconstruction in patients with osteoradionecrosis of the jaws (ORNJ). METHODS: From March 2014 to July 2017, 40 patients with mandibular ORNJ undergoing oral and maxillofacial surgery at Sun Yat-sen Memorial Hospital of Sun Yat-sen University were enrolled. All patients had primary nasopharyngeal carcinoma, excluding recurrent nasopharyngeal carcinoma. Free peroneal dermis fascia composite flap was used to reconstruct bone defects after surgical resection of the radiated mandibular necrosis. The skin and soft tissue defects were repaired with skin island. Fascia was used for mucosal defect repair to fill the soft tissue defects. The fibular osteotomy and tissue flap survival, donor, complications, postoperative mouth opening and occlusion of remaining teeth were evaluated for reconstruction outcomes. RESULTS: After 3 to 6 months of follow-up, free fibular peroneal fascial composite flap was successfully used to reconstruct mandibular defects. Mandibular osteotomy was 5.5-16.0 cm in length, and the harvested fibula was 7.5-17.0 cm in length. No patient had serious donor or recipient site complications. All patients had satisfactory facial shape, remaining normal occlusion, and mouth opening was 1.0-3.5 cm. CONCLUSIONS: Free fibular peroneal fascia composite flap can reconstruct maxillofacial soft and hard tissue defects after radio in patients with ORNJ and reduce complications, which is worthy of clinical application.

Key words: Mandible, Osteoradionecrosis, Fibular osteomyofascial compound flap

中图分类号:

R782.2

刘军平，李群星，张汉卿，欧展鹏，范松，李劲松. 游离腓骨肌-皮-筋膜复合瓣同期修复40例放射性下颌骨坏死术后缺损效果评价[J]. 中国口腔颌面外科杂志, 2018, 16(3): 270-274.

LIU Jun-ping, LI Qun-xing, ZHANG Han-qing, OU Zhan-peng, FAN Song, LI Jin-song.. Efficacy and safety of reconstruction of mandibular defect in 40 patients with osteoradionecrosis of the jaw with free fibular osteomyofascial compound flap[J]. China J Oral Maxillofac Surg, 2018, 16(3): 270-274.

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游离腓骨肌-皮-筋膜复合瓣同期修复40例放射性下颌骨坏死术后缺损效果评价

Efficacy and safety of reconstruction of mandibular defect in 40 patients with osteoradionecrosis of the jaw with free fibular osteomyofascial compound flap

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