腓骨垂直牽引術的併發症處理及人工植體的長期追蹤報告

Complication Treatment of Fibular Bone Vertical Distraction Osteogeneis and Outcome of Dental Implants-Long Term Follow Up

張陽明(Yang-Ming Chang) ； 陳志魁(Jyh-Kwei Chen)

《臺灣口腔顎面外科學會雜誌》 29卷4期 (2018/12) Pp. 231-240

摘要

本篇報告評估以腓骨皮瓣應用於下顎骨重建手術後，以垂直牽引術方式提高新齒槽嵴高度的併發症處理及人工植體種植後的長期追縱。從2003到2016年共有16例，包含顏面外傷1例、中心巨細胞瘤1例、鱗狀上皮癌術後未經放射治療4 例、造釉細胞瘤10例。9位男性、7 位女性。年齡16歲到61歲。垂直牽引後的齒槽嵴平均增加了11.57 mm。共45支植體種植於新齒槽骨內，但有一支植體在義齒製作過程中脫落，共12例完成義齒贋復，平均8年的追踪植體存活率達98%。牽引手術的併發症包括傷口裂開、感染、牽引基底板斷裂、牽引過程中腓骨與自然齒槽骨按合處斷裂、牽引過程中牽引轉動軸舌側傾斜或牽引桿頭斷裂等。所以腓骨牽引手術除了腓骨皮瓣可以維持下顎骨的外形之外，牽引手術增加了齒槽骨的高度，再加上人工植體的合併使用、能夠回復病患 的咀嚼功能；是可以被考慮的術式。

關鍵字

垂直高度牽引 ； 隱藏修復期 ； 固化期

並列摘要

This study investigated the long-term treatment outcomes of the complication managements and oral implants in segmental mandibular reconstructions using free fibular bone flaps. Between 2003 and 2016, a total of 16 patients (9 males, 7 females), age ranged from 16 to 61 years old, underwent fibular bone vertical distraction in segmental mandibular reconstruction. The diagnosis included facial trauma (n = 1), central giant cell granuloma (n = 1), squamous cell carcinoma without radiotherapy (n = 4), and ameloblastoma (n = 10). The vertical bone increasement resulting from distraction osteogenesis was 11.57 mm on average. A total of 45 oral implants were performed on 12 patients, there was only one (n = 1) failed during the following prosthetic treatment. The overall implant survival rate was 98% in 8 years of follow-up. The other minority of complications included local infection and wound dehiscence; some more challenging complications, such as, fracture of the base plate on the distraction device, fracture of the immobile lower fibula half at its junction with the native mandible during horizontal distraction process, lingual transportation of the vertical distracted segment and fracture of distraction rod were also treated and subsequently healed uneventfully. Therefore, vertical distraction osteogenesis on free fibular bone flap may be considred as a common procedure in segmental mandibular reconstruction. This intervention provides several advantages, such as maintenance of the contour of mandibles, and increasement of vertical alveolar height. In a combination of other dental restorations, the occlusal function of the patient can be greatly improved.

並列關鍵字

Vertical distraction osteogenesis ； Latency ； Consolidation