2种骨肌皮瓣修复放射性下颌骨坏死术后缺损的临床评价

摘要

Objective:To evaluate the clinical outcomes of 2 kinds of osteocutaneous flap in the treatment of mandibular osteoradione-crosis.Methods:35 cases with mandibular osteoradionecrosis were treated by partial mandibulectomy and bone graft according to de-fect size and patients'requirements.The defects in 7 patients were reconstructed with iliac osteocutaneous flap and 28 with fibular os-teocutaneous flap.All flaps and wounds were monitored regularly.Results:One flap with venin crisis was observed in the patients treated with iliac osteocutaneous flap,its skin island was failed but the bone graft was survived.In the fibular osteocutaneous flap group,3 flaps with vein crisis were observed.2 of them were failed and 1 was rescued after second surgery.The most common compli-cations were infection,delayed wound healing and scar.The appearance and function were all satisfied and limitation of mouth opening was improved after surgery.Conclusion:Both of fibular osteocutaneous flap and iliac osteocutaneous flap can be applied in the defect reconstruction of patients with mandibular osteoradionecrosis.Fibular osteocutaneous flap is a good choice for huge mandibular defect and iliac osteocutaneous flap seems more esthetical.%目的：比较2种骨肌皮瓣修复放射性下颌骨坏死的疗效及优缺点。方法：手术切除坏死下颌骨及其周围软组织，根据骨缺损大小及患者要求选择腓骨肌皮瓣或髂骨肌皮瓣进行修复，观察组织瓣存活情况，记录创口愈合情况、供区和受区并发症以及手术前后开口度和咬合情况，评价颜面外形和功能恢复效果。结果：本组7例采用髂骨肌皮瓣修复，其中1例出现血管危象，探查后骨瓣存活但皮瓣坏死，2次植皮后创口愈合，其余6例存活良好；28例采用腓骨肌皮瓣修复，其中3例出现血管危象，探查后2例组织瓣存活，1例失败取出。2种修复方式的局部并发症主要为创口感染、延期愈合和供区瘢痕。2组患者术后颜面外形和咬合功能恢复良好，开口度有不同程度改善。结论：腓骨肌皮瓣和髂骨肌皮瓣均可用于放射性下颌骨坏死术后缺损修复，对缺损范围较大的患者主要选择腓骨肌皮瓣，对腿部美观有较高要求的患者可选择髂骨肌皮瓣。