以重疊腓骨皮瓣合併人工植體種植術應用於下顎骨腫瘤切除後植體功能負載的評估

Dental Implants Outcome in Double Barrel Fibula Bone Flap for Segmental andibular Defect Reconstruction

林秀娜(Shiu-Na Lin) ； 張陽明(Yang-Ming Chang) ； 魏福全(Fu-Chen Wei)

《臺灣口腔顎面外科學會雜誌》 27卷1期 (2016/03) Pp. 12-20

摘要

於2005年至2008年間，共13位病患。男性9位、女性4位，年23至65歲；造釉細胞瘤8位、惡性腫瘤5位。腫瘤切除後，下顎骨缺損以腓骨皮瓣合併立即人工植體種植術，重建病患口腔呕嚼功能。結果：以口蓋侧黏膜移植於植體周圍的病患（8位，18支植體），相比僅以覆蓋於重建骨上之皮瓣結缔組織打薄修整後留下l-2mm厚的角質上皮組織，缝合於植體周圍處者（5位，18支植體）；經平均63.7個月（28-77個月）的咀嚼功能追踪。發現前者的植體周圍骨吸收率，遠低於後者(F＜0.01)。結綸：同樣是角質化上皮組織，而口蓋侧角質黏膜提供了較皮膚層結缔組織更好的植體周圍貼合效果，減少了植體周圍炎的產生。也減少了植體周圍骨的被吸收速度，有利病患進行口腔衛生照護。

關鍵字

重疊腓骨皮瓣 ； 功能負載

並列摘要

Several methods have been developed to overcome the height discrepancy between the native mandible and the transplanted fibula. For example, vertical distraction osteogenesis, or double barrel technique. From 2005 to 2008, 13 patients (9 males, 4 female), age 23 to 65 years old. 8 patients of ameloblastoma and 5 patients of malignant tumor underwent segmental mandibular defect reconstruction and oral functional rehabilitation, using double barrel fibula osteosepto-cutaneous flap combined with dental implants. The implant marginal bone loss was evaluated at an average of 63.7 months after implant functional loading. 13 patients with a total of 36 osseointegrated implants were divided to two groups: palatal mucosa (n=18) and skin trimming flap (n=18) were evaluated. The mean implant marginal bone loss was 0.50±0.46 mm at the mesial surface and 0.56±0.49 mm at the distal surface. All implants were loaded. Cross sectional height of fibula is 11.8 mm (ranged from 8.4 to 14.6 mm)and a mean double-barred height of 29.6 mm (ranged from 21.1 to 36.2 mm) increase of 16.8mm and increase bone height ratio of 2.42. Marginal bone loss of implants without palatal mucosa graft (0.79±0.50 mm) was significantly worse than implants with palatal mucosa graft (0.21±0.10 mm，P ＜ 0.001) and distal surface without palatal mucosa graft (0.84±0.55 mm) the palatal mucosa graft (0.28±0.15 mm，P ＜ 0.001).This method maintained not only esthetic profile was maintained but also oral functional was obtained. Furthermore, firmly attached gingival like palatal mucosal grafts prevent peri-implant soft tissue inflammation and facilitate maintenance of oral hygiene.

並列關鍵字

Double-barrel fibula flap ； Functional loading