以可吸收性骨釘與骨板應用於顏面骨骨折及腫瘤切除後重建之分析

Clinical Analysis of Biodegradable Fixation Material for Reconstruction of Facial Bone Fracture and Oral Cancer Post-mandibulotomy

李芳輝(F H Lee) ； 許文祥(T S Lin) ； 林廷宣(W S Hsu) ； 林瑞芬(J F Lin) ； 羅正興(C H Lo)

《臺灣口腔顎面外科學會雜誌》 20卷2期 (2009/06) Pp. 75-83

https://doi.org/10.7104/TJOMS.200906.0075

摘要

研究背景：基於迷你鈦金屬骨釘、骨板植入之患者易有異物感且有可能二次感染，統計上約有20%的患者需有二次手術將骨釘骨板移除之情形，於是近幾年來遂發展出可水解之可吸收性骨材，其主要目的是要取代金屬骨材造成的問題。可吸收性材料之降解速度受到材質特性的影響，所以我們收集本科民國93年元月至96年元月共43例患者，平均年齡爲42.5歲，評估外消旋聚乳酸和聚乳酸的共聚物(DLPLA, L, D-lactide，Inion(上標 ®))材質之吸收性骨釘與骨板，應用於外傷性顏面骨骨折及腫瘤切除後重建之可行性。
方法與材料：下顎骨及勒福氏骨折施行開放性復位及可吸收骨釘、骨板固定並輔以上下顎間固定2~4週；顴骨上顎骨骨折則無上下顎間固定；口腔癌手術併行下顎骨截骨術後之復位固定。
結果：除了有1例下顎副聯合骨折因切口皮瓣設計不良，以致初期骨板外露外，另外於眼眶骨下緣、下顎骨角及上顎骨各有1例於骨板吸收過程產生感染，平均發生時間爲術後9.5個月，經引流、清創後傷口癒合正常。其餘患者顯示骨折癒合正常，穩定的上下顎咬合關係與對稱的顏面外觀。
結論：可吸收性骨釘骨板使用於顱顏區是可信賴的。

關鍵字

迷你鈦金屬骨釘骨板 ； 可吸收性骨釘骨板 ； 外傷性顏面骨骨折 ； 下顎骨截骨術

並列摘要

Backgrounds: Patients who receive titanic miniplate implants would have foreign body sensation and the chance of a secondary infection. There are also reports that around 20% of these patients have to remove titanic implants due to above reasons. Resorbable plates and screws have been developed to overcome the disadvantages of titanic miniplates. The degradation of resorbable plates and screws depends on the material's properties.
Materials & Methods: From Jan. 2004 to Jan. 2007, there were 43 cases, mean age 42.5y/o, used to evaluate the clinical application of L,D-lactide miniplate system (DLPLA, Inion) in the reconstruction of facial bone fracture and oral cancer post-mandibulotomy.
Results: There were 3 cases who had complications with delayed infection in the orbital rim, maxilla and mandibular angle regions and 1 case who had a plate exposed due to improper incision in the mandibular parasymphysis region. All the remaining patients enjoyed good results cosmetically as well as in occlusion and facial bone union. The mean time of infection for the 3 cases was around 9.5 months post operation. However, with proper debridement and drainage, all the infected wounds healed well.
Conclusions: Biodegradable fixation material has been shown to be reliable for use in maxillofacial regions.

並列關鍵字

titanic implant ； biodegradable implant ； facial bone fracture ； mandibulotomy