赝复体用于上颌骨组织缺损修复的临床回顾研究

摘要

Objective: To evaluate the clinical effect of prosthesis on patients with maxillary defect.Methods: Thirty-six patients with maxillary defect restorated by means of prosthesis were involved in this study, including 22 male and 14 female.Each patient was classified under Aramany and YM Zhao's rule.Prosthesis made with PMMA with or without Ti, Co-Cr alloy and soft ling materials according to the conditions and demands of patients.Two patients with unilateral orbital defect were restorated with an orbital implant.All patients were instructed to wear prosthesis daily.The retention, stability, oral-nasal seal and speech intelligibility (SI) of prosthesis were examined after 2 weeks and 1 year.Results: The retention and stability of prostheses in 3 cases classified as Aramany VI were not satisfying, even relined with soft linging material.While other prostheses got satisfactory results.The oral-nasal seal of all prosthesis was enough.Patients wearing resilient prosthesis described high degree of satisfaction after soft linging.The mean SI score with and without prosthesis were (73.4±4.2)% and (34.6±5.9)%, with statistical differences (P<0.05).Conclusion: Prosthesis of maxillary defects could supply enough oral-nasal seal and speech intelligibility.The use of soft lining material in prostheses of maxillary defects could improve retention and stability.The retention and stability of prostheses in patients as Aramany VI were not satisfying, and further study should be accomplished in order to achieve satisfactory results.%目的:评价赝复体在一侧上颌骨缺损修复中的应用及临床效果.方法:回顾分析研究组2004年6月至2009年12月采用赝复体进行上颌骨缺损修复的36例患者的短期临床效果检查.按照Aramany分类I类10例,II类3例,III类2例,IV类7例,V类11例,VI类3例;按照赵铱民分类I类3例,II类12例,III类3例,IV类2例,V类9例,VI类7例;同时有3例患者伴单侧眼眶缺损.常规方法采用PMMA单独或与纯钛、钴铬合金及软衬材料联合制作赝复体,3例伴随单侧眼眶缺损患者进行义眼台制作.嘱患者每天戴用赝复体,于修复体戴入并调改完成后2周进行临床效果评价,检查其固位、稳定性,口鼻腔封闭作用及语音清晰度等.结果:36例患者赝复体戴入后均能较快掌握取戴方法,3例Aramany分类VI类的患者赝复体固位相对较差,其余患者赝复体固位较好;所有赝复体口鼻腔封闭作用均较好,患者诉软衬材料组患者舒适度优于其余材料修复体;患者佩戴赝复体前后的语音清晰度分别为(34.6±5.9)%和(73.4±4.2)%,差异有统计学意义(P <0.05).结论:上颌骨缺损后赝复体修复可以提供口鼻腔封闭作用,提高患者语音清晰度;软衬材料应用于一侧上颌骨缺损能够增加修复体的固位稳定性,改善语音清晰程度.但对于Aramany分类VI类的患者仅靠基牙与固位体不能完全满足固位要求,尚需更多努力以较好的恢复患侧缺失组织的形态和功能.