摘要
目的 总结陈旧性颅颌面骨创伤畸形和额、颞、颧、鼻骨及上下颌骨缺损的修复方法 ,随访各种修复材料植入后的变化 ,比较自体骨移植与生物材料植入的治疗效果。方法 将 1995年以来收治的各种颅颌面骨创伤畸形及骨缺损的 87例患者分为两组 ,分别采用LeFortOne截骨、下颌骨矢状劈开截骨、颅眶截骨重塑进行修复 ,恢复颅颌面骨的解剖形态和牙齿的咬牙合功能。对于骨缺损的患者选择自体骨移植和生物材料植入进行治疗 ,术后随访 3～5年 ,通过头颅X线定位片投影测量、面部轮廓测量、CT片及三维CT重组 ,了解植入物的变化、吸收程度、固定装置对组织的影响和面部的对称情况。结果 自体骨移植尤其是带血管蒂的骨移植 ,愈合快 ,吸收少。游离骨移植效果比较好 ,但是骨吸收较大 ,吸收率达 2 6 .5 %～ 4 1.8%。生物材料如Medpor、Gore -Tex、钛合金固定装置、人工骨的相容性好。硅橡胶、羟基磷灰石及记忆合金均有植入后发生组织反应而取出的病例。结论 带血供的自体骨移植修复颅颌面骨创伤畸形及骨缺损是最佳治疗方法。应用Medpor、Gore -Tex植入修复骨缺损疗效稳定 ,创伤小 。
Objective To conclude the repair method of old deformities of craniomaxillary injuries and bone defects at frontal, temporal, zygomatic, nasal bone, maxilla and mandibule, to track the changes of various implanted repairing materials, and to compare the results between autologous bone transplantation and biomaterial implantation. Methods From 1995, 87 cases with various deformities and bone defects after craniomaxilla injuries were designed into two groups: autologous bone transplantation and biomaterial implantation. All cases were followed up for 3～5 years post-operativelywith X-ray cephalometrics, facial profile measure, CT and 3-D CT reconstruction to reveal the changes in the implant, degree of absorption, effects of fixation on tissue, and the facial symmetry. Results Autologous bone transplantation, especially pedicled bone transplantion, healed rapidly and had less absorptions so that it′s still the optimal treatment method. Free bone transplantation is a good approach but the absorption degree is high, amounting to 26.5%～41.8%. The compatibility of biomaterials is good, such as Medpor, Gore-Tex, Titanium fixation, artificial bone, and the treatment result is stable, however silicone rubber, hydroxyapatite and shape memory alloy had to be removed in several instances due to tissue reaction. Conclusion Autologous pedicled bone transplantation shows to be the optimal treatmemt plan. Repairs of bone defects with Medpor or Gore-Tex are straight forward with stable outcomes and minor trauma.
出处
《实用美容整形外科杂志》
2003年第5期244-247,共4页
Journal of Practical Aesthetic and Plastic Surgery
