Reconstruction of Mandibular Fractures with Biodegradable Implants: -The 5-year Experience of A Single Institution

以生物可吸收骨材重建下頷骨骨折－新光醫學中心的五年經驗

張峰瑞(Feng-Jui Chang) ； 林煌基(Hwang-Chi Lin) ； 鄭舉緒(Chu-Hsu Jeng) ； 陳韋全(Wei-Chuan Chen,) ； 謝承翰(Cheng-Han Hsieh) ； 林育賢(Yu-Hsien Lin) ； 羅國銓(Kuo-Chuan Lo) ； 陳柵君(Cha-Chun Chen)

《臺灣整形外科醫學會雜誌》 21卷4期 (2012/12) Pp. 273-283

https://doi.org/10.7096/TJTSPS.201212.0273

摘要

背景：對於下頷骨骨折的病人，標準的方法是鈦金屬作為固定的材料。但是，鈦金屬植入物相關併發症的產生也導致生物可吸收骨材有發展，以作為臨床的使用上的另一種選擇。目的及目標：我們回溯性的調查在過去五年中於新光醫學中心，對於下頷骨骨折的病人使用生物可吸收骨材作為內固定的材料，並追蹤其治療成效。材料及方法：從2006/8至2011/3，一共有32個下頷骨骨折的病人接受治療（共有42骨折處）。其中有20位男性及12位女性。我們使用盈力恩®-生物可吸收性骨釘骨板（Inion®）作為下頷骨的固定材料。結果：病人的年齡分布由16至69歲（平均30.5歲）。所有病人術後皆接受上下顎間固定術，時間由2天至25天（平均18天）。追蹤時間由3個月至61個月（平均30.5個月）。六個病人術後產生併發症，包括三位病人發生手術後傷口感染，一位病入在手術部位有持續性的腫塊，二位病人有術後咬合不良的問題，需接受後續咬合矯正治療。其中兩位病人最後需取出植入物。所有病人經過適當的治療後，所有病人都恢復良好。結論：以生物可吸收骨材重建下頷骨骨折，提供了另人滿意的初步結果。它的優點包括生物相容性大及可以在體人逐步分解，並避免金屬植入物的相關併發症產生。但是生物性骨材也有它的限制及缺點，並不能完全取代鈦金屬骨材。在臨床使用上，也需選擇適當的病人。對於術後的病人，我們建議術後仍需要上下顎間固定術作為輔助。至於上下顎間固定的時間則需依醫師的個人經驗，及術後臨床上病人的咬合程度及穩定度而有所調整。未來的方向包括長期的追蹤及評估植入物對人體影響，及設計隨機臨床試驗以作為治療的參考。

並列摘要

Background: Titanium plating is the standard of treatment for mandibular fractures, but certain material-related disadvantages led to the development of biodegradable implants as an alternative. Aim and Objectives: To review the 5-year experience in our hospital of treatment and outcomes of mandibular fractures with biodegradable plates. Materials and Methods: From August 2006 to March 2011, forty-two fracture sites of the mandible in 32 patients (20 male, 12 female) were treated with the Inion® biodegradable system. The patients' age ranged from16 to 69 years (mean 30.5 years). The time between injury to operation with fixation ranged from 1 to 14 days (mean 5.1 days). All patients had postoperative intermaxillo-mandibular fixation (IMF) applied within 2-25 days (mean 18 days). Results: Wound healing was uneventful in most patients, with good cosmetic results as well as occlusion and bone healing. Postoperative complications were transient and limited to wound dehiscence and localized wound infection (three patients, 9.37%). One patient (3.12%) had a persistent palpable mass at the operative site without infection. Overall two patient (6.25%) had plate removal due to infection and persistent mass at operative site. Two patients (6.25%) had malocclusion and treated by orthodontic depatment with occlusive adjustment or even the orthodontic treatment. Implant-related serious adverse tissue reactions were not observed during the follow-up (mean, 30.5 months; range 3 to 61 months). Conclusion: The biodegradable implants provide satisfactory reduction and fixation in selective cases of mandibular fractures. With their advantages of biocompatibility and degradation property, biodegradable implants avoid the disadvantages of metal implants and provide satisfactory bone healing. But biodegradable plates can not replace metallic plates in all cases and should be used selectively. Postoperative intermaxillo-mandibular fixation is suggested, although the period varies and depends on the clinical examination of occlusion and stability of the fracture sites. Future studies should include long-term clinical follow-up and randomized controlled tests.

並列關鍵字

mandible ； fractures ； biodegradable ； bioresorbable ； resorbable implants ； intermaxillo-mandibular fixation