使用附骨髓內釘可易曲性肋骨移植術的下頜骨重建

Fabricating Rib Bone Graft with Intra-Medullar Pin for Reconstruction of Mandible

張寬敏(Kuan-Min Chang) ； 楊博正(Pao-Jen Yang) ； 王建哲(Chien-Che Wang)

《中華民國重建整形外科醫學會雜誌》 4卷1期 (1995/03) Pp. 57-64

https://doi.org/10.7096/JPRSA.199503.0057

摘要

對下頜骨切除後的廣範圍缺損之重建，1900年Skyloff創始助骨移植術以後，有腸骨鬆質骨，骨髓及骨碎片等移植術，或塑膠、尼龍、矽化物及金屬性人工材料裝填術等各種重建治療。其成果各優劣。最近幾年來有顯微手術的進步，使帶血管的腸骨、肩胛骨、或排骨移植已漸徐獲得良好的成果。但為適進下頜的彎曲度要對移植骨做多處截骨術來配合下頜骨的外型，然後還要使用金屬板、螺絲釘來因定其骨片。著者報告易造型、便宜、而有效的可易曲性肋骨移植術之症例，並提案應用本法，即對腓骨骨髓內金屬釘裝入的造型法。

關鍵字

下頜骨缺損 ； 骨移植 ； 重建術

並列摘要

A fresh autogeneous rib bone graft is commonly used in the correction of a long distanced discontinued mandibular defect after hemimandibulectomy. The cortical plate of rib was vascularized easily after grafting. But solid rib is difficult to achieve satisfactory cosmetic results. Bending of rib bone for adjusting the defect is occasionally difficult without fracturing it. Hence some authors fabricated rib by a Greenstick frascture to form a suitable curve or used rib which is decorticated upper and lower margins and is with multiple vertical saw cuts through the cocave side. But these cuts promote the rib can be bent only in horizontal direction. This article presents the clinical experiences of two cases of mandibular; discontinuity defect that were reconstructed using fabricated autogeneous rib bone graft with intra-medullar pin. That is by means of pliable rib bone which fabicating with multiple vertical cuts on its upper and lower margins and importion of vitallium pin (1.0-1.5mm in diameter) through a medullar cavity. A series of incomplete saw cuts vertically on both margins of a rib facilitate bending of it horizontally and vertically to the desired contour. Imported pin has acted as templet in restoring the contour too. First case was 31-year old male who suffered from Ameloblastoma on his left mandible since five years ago. A long distanced discontinued defect of mandible was reconstructed with above method. Follow up on two years after grafting showed that acceptable esthetic and functional results were obtained. Second case was 37 years old female who suffered from gingival bleeding and inflammatoric swelling on left mandible since two years ago and had been operated once at other clinic one year ago without cure. On admission we determined that about fist in size septic granulomatous swelling ruptured out through a left submandibular skin. X-ray showed highly bony-destructed shadow of left mandible. Biopsy confirmed as squamous cell carcinoma. We did wide resection of the lesion and hemimandibulectomy with radical neck lymph nodes dissection. Temporart fixation by vitallium pin and intermaxillar joining were done. After improvemeny of an local infection extending defect of soft tissue was repaired with Bakamjian flap by staged operations. Three months later we reconstructed bone defect with the presented method. Patient discharged on 9 th postoperative day and attended our OPD. during seven months with uneventful course. But two and half years later patient expired due to recurrence.
The present method has adventages of (1)pliability, (2)ease of shaping, (3)minimal tissue reaction, (4)reduced chance of dehiscence, (5)not necessary of preoperative fabrication etc. Recently with the evolution of microsurgery free tissue flap transfer is an alternative for head and neck reconstruction. For larger defect or those that involve the mandibuladr angle, free vascularized fibula bone graft may be more adventageous, During above procedure, stabilization of the grafting bone must depend on reconstruction metal plate and multiple screws fixation after osteotomy. But reconstruction plate can be exceptionally difficult to contour, espicially when multidirectional bends are required. This problem may be solved by application of the presented fabrication method, that is to insert vitallium pin into a fibula's marrow cavity prior to osteotomy and then complete fabrication without necessity of any reconstruction plate, screw fixation.

並列關鍵字

mandibuar defect ； bone graft ； reconstruction