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  • 學位論文

使用生物可吸收性poly-5D/95L-lactide (PLA95)聚合物骨板螺釘治療節段性下頜骨骨折

Use of bioabsorbable poly-5D/95L-lactide (PLA95) copolymer plates & screws in treatment of segmental mandibular fracture

指導教授 : 韓志平

摘要


顏面骨折是相當常見的傷害,下頷骨骨折約佔40-50 %,其中下頷骨多處骨折又佔所有下頷骨骨折將近一半。在治療下頷骨骨折上,正確的骨折復位與穩定的癒合是達到成功的咬合重建及功能復健最重要的條件。由於有兩處以上的骨折會造成了許多額外複雜的力學向量,這些力量的交互影響,使得下頷骨多處骨折在治療上比單純下頷骨骨折更為複雜。目前仍然以手術復位及內固定為主要治療方式。所使用之內固定材質以鈦金屬迷你骨板螺釘為主,這種方式為大多數整形外科及口腔顎面外科醫師所採用。生物可吸收材料最早大約40年前就被提出介紹,並有各種不同型態的聚合物在市場上可供選擇。雖然已有許多使用生物可吸收骨板螺釘成功治療顱顏面骨折的報告,但卻只有少數討論到下頷骨骨折(mandibular fracture),且多局限在無位移(non-displaced)的骨折。生物可吸收骨板螺釘由於材質較軟,力學性能較金屬差,所以很少大規模應用於治療負載力量較大的下頷骨骨折的臨床報告,尤其是對節段性下頷骨骨折(segmental mandibular fracture) 更未見有臨床研究或專文討論。這是一個回顧性研究,報告我們使用一種生物可吸收材料(poly-5D/95L-lactide (PLA95)) 聚合物骨板和螺釘 (Bonamates ®; BioTech One, Taipei, Taiwan)應用於治療節段性下頷骨骨折骨內固定的臨床資料。共有 11 例包括 7 名男性和4名女性,其年齡介於 18~ 85歲(平均年齡 33.9歲)。 術後追蹤6.5 ~ 26.5個月(平均13 個月)不等。受傷原因以交通事故為主共十例,另一例為墜樓意外。有三例病患同時合併單側顴骨骨折。一名病人有術後的併發症需要進一步治療。有一例無法追蹤,其餘十例皆顯示主觀或客觀良好臨床結果及高滿意度。透過生物工程科技的進步,目前生物可吸收骨板螺釘系統幾乎可以達到類似金屬板的強度,可更有信心使用在顏面骨骨折,甚至在高負載力的下頷骨骨折的固定。到目前為止,生物可吸收骨板和螺釘仍有其未克服的問題,如體積較大、在完全吸收前的異物反應、或價格等,尚不能完全取代鈦金屬骨板和螺釘。在較複雜或粉碎性骨折(comminuted fracture),或開放性污染傷口的骨折,有其使用上的禁忌症(contraindication)。Bonamates ® PLA95設備似可為臨床治療節段性下頷骨骨折的固定提供另外的選擇。 關鍵字:節段性下頷骨骨折、生物可吸收骨板螺釘、PLA95

並列摘要


Fracture of facial bone is quite a common injury and mandibular fracture cases are about 40-50 % of them. Multiple fracture of mandible is about half of all mandibular injury. Anatomic reduction and stable union of fractured bone are the key to achieve successful restoration of occlusion and function. On account of excessive and complicate mechanical vectors interactions in mandible with more than two fracture sites, more difficulty was encountered in treatment of multiple mandibular fracture than simple fracture. Open reduction and internal fixation with titanium plates and screws had been widely used by plastic and orosurgical doctors in the management of mandibular fracture. Bioresorbable material was first introduced about 40 years ago and many different types of copolymers had been commercial available. There were many literatures reported their successful treatment in facial bone fracture using bioresorbable devices however, only few were focused on mandibular fracture, mostly on non-displaced fracture. Bioresorbable devices were not widely used for fixation in high load area such as mandibular fracture, rarely in segmental mandibular fracture. We use poly-5D/95L-lactide (PLA95) (Bonamates ®; BioTech One, Taipei, Taiwan) plates and screws for treatment of segmental mandibular fracture in this prospective study with total 11 patients which include 7 males and 4 females and the age ranged from 18 to 85 year-old. The period of post-operative follow up varied from 6.5 months to 26.5 months (average 13.5 months). The cause of injury was ten of traffic accident and one of falling down. All, except one loss of follow up, of them revealed satisfactory result subjectively and objectively. Through the advancement of bio-technology, the bioabsorable implants could provided adequate strength similar to metal and could be used safely in fixation of fracture of facial bone even in high load area such as mandibular fracture. Although the bioabsorbable implants had the drawback such larger volume, foreign body reaction before complete degradation, high cost and also contra- indicated in contaminated or comminuted fracture, it seem provided an alternative for the treatment of segmental mandibular fracture. Key words: segmental mandibular fracture, bioabsorable plates and screws, PLA95

參考文獻


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