血管化游离腓骨重建下颌骨缺损垂直骨量不足的解决方案研究进展
Research Progress on Solutions to Insufficient Mandibular Height after Vascularized Free Fibula Reconstruction for Mandibular Defects
DOI: 10.12677/acm.2025.1541074, PDF,   
作者: 李麒麟, 刘雁鸣*：浙江大学医学院附属第二医院口腔颌面外科，浙江 杭州
关键词: 下颌骨缺损；游离腓骨瓣；双层腓骨瓣；种植；Mandibular Defects； Free Fibular Flap； Double-Barrel Fibular Flap； Implant
摘要: 肿瘤切除、外伤、感染等因素常常造成下颌骨缺损，严重影响患者面容及功能，血管化骨移植是重建下颌骨缺损的金标准，其中游离腓骨瓣长久以来被视为重建下颌骨缺损的首选皮瓣，然而，腓骨垂直高度仅为下颌骨一半左右，重建后垂直骨量明显不足，影响后续种植修复，随着外科技术的发展，这一问题也得以解决。本文主要讨论目前腓骨重建下颌骨高度不足的各种解决方案，并分析比较各种方法的优缺点及临床效果，以期为临床医生提供参考。
Abstract: Mandibular defects often result from factors such as tumor resection, trauma, and infection, significantly affecting patients’ facial appearance and function. Vascularized bone grafting is the gold standard for reconstructing mandibular defects, among which the free fibula flap has long been regarded as the preferred flap for mandibular reconstruction. However, the vertical height of the fibula is only about half of that of the mandible, leading to a significant deficiency in vertical bone volume after reconstruction and affecting subsequent implant restoration. With advancements in surgical techniques, this issue has been addressed. This article primarily discusses various solutions to the problem of insufficient mandibular height after fibular reconstruction, and compares the advantages, disadvantages, and clinical effects of each method, aiming to provide a reference for clinicians.
文章引用：李麒麟, 刘雁鸣. 血管化游离腓骨重建下颌骨缺损垂直骨量不足的解决方案研究进展[J]. 临床医学进展, 2025, 15(4): 1417-1423. https://doi.org/10.12677/acm.2025.1541074

参考文献

[1] Urken, M.L., Buchbinder, D., Weinberg, H., Vickery, C., Sheiner, A., Parker, R., et al. (2015) Functional Evaluation Following Microvascular Oromandibular Reconstruction of the Oral Cancer Patient: A Comparative Study of Reconstructed and Nonreconstructed Patients. The Laryngoscope, 125, 1512-1512. [Google Scholar] [CrossRef] [PubMed]
[2] Cordeiro, P.G., Disa, J.J., Hidalgo, D.A. and Hu, Q.Y. (1999) Reconstruction of the Mandible with Osseous Free Flaps: A 10-Year Experience with 150 Consecutive Patients. Plastic and Reconstructive Surgery, 104, 1314-1320. [Google Scholar] [CrossRef] [PubMed]
[3] Wilkman, T., Husso, A. and Lassus, P. (2018) Clinical Comparison of Scapular, Fibular, and Iliac Crest Osseal Free Flaps in Maxillofacial Reconstructions. Scandinavian Journal of Surgery, 108, 76-82. [Google Scholar] [CrossRef] [PubMed]
[4] Lai, Y., Lai, Y. and Lee, Y. (2023) Impact of Fibula Osteoseptocutaneous Flap Laterality in Mandibular and Intraoral Reconstruction. Journal of Plastic, Reconstructive & Aesthetic Surgery, 86, 199-204. [Google Scholar] [CrossRef] [PubMed]
[5] Horiuchi, K., Hattori, A., Inada, I., Kamibayashi, T., Sugimura, M., Yajima, H., et al. (1995) Mandibular Reconstruction Using the Double Barrel Fibular Graft. Microsurgery, 16, 450-454. [Google Scholar] [CrossRef] [PubMed]
[6] Bähr, W., Stoll, P. and Wächter, R. (1998) Use of the “Double Barrel” Free Vascularized Fibula in Mandibular Reconstruction. Journal of Oral and Maxillofacial Surgery, 56, 38-44. [Google Scholar] [CrossRef] [PubMed]
[7] Muñoz Guerra, M.F., Gías, L.N., Rodriguez Campo, F.J., Pérez, J.S., de Artiñano, F.O. and Diaz Gonzalez, F.J. (2000) The Partial Double-Barrel Free Vascularized Fibular Graft: A Solution for Long Mandibular Defects. Plastic and Reconstructive Surgery, 105, 1902-1903. [Google Scholar] [CrossRef] [PubMed]
[8] He, Y., Zhang, Z.Y., Zhu, H.G., Wu, Y.Q. and Fu, H.H. (2011) Double-Barrel Fibula Vascularized Free Flap with Dental Rehabilitation for Mandibular Reconstruction. Journal of Oral and Maxillofacial Surgery, 69, 2663-2669. [Google Scholar] [CrossRef] [PubMed]
[9] Chang, Y., Wallace, C.G., Tsai, C., Shen, Y., Hsu, Y. and Wei, F. (2011) Dental Implant Outcome after Primary Im-plantation into Double-Barreled Fibula Osteoseptocutaneous Free Flap-Reconstructed Mandible. Plastic and Reconstructive Surgery, 128, 1220-1228. [Google Scholar] [CrossRef] [PubMed]
[10] Trilles, J., Chaya, B.F., Daar, D.A., Anzai, L., Boczar, D., Rodriguez Colon, R., et al. (2021) double‐Barrel versus Single‐Barrel Fibula Flaps for Mandibular Reconstruction: Safety and Outcomes. The Laryngoscope, 132, 1576-1581. [Google Scholar] [CrossRef] [PubMed]
[11] Ulkur, E., Karagoz, H., Kulahci, Y., Suer, B.T., Oksuz, S., Kocyigit, I.D., et al. (2013) One-and-a-Half-Barrel Vascularized Free Fibular Flap for the Reconstruction of Segmental Mandibular Defect. Journal of Craniofacial Surgery, 24, e167-e169. [Google Scholar] [CrossRef] [PubMed]
[12] Klesper, B., Lazar, F., Sießegger, M., Hidding, J. and Zöller, J.E. (2002) Vertical Distraction Osteogenesis of Fibula Transplants for Mandibular Reconstruction—A Preliminary Study. Journal of Cranio-Maxillofacial Surgery, 30, 280-285. [Google Scholar] [CrossRef] 
[13] Nocini, P.F., Wangerin, K., Albanese, M., Kretschmer, W. and Cortelazzi, R. (2000) Vertical Distraction of a Free Vascularized Fibula Flap in a Reconstructed Hemimandible: Case Report. Journal of Cranio-Maxillofacial Surgery, 28, 20-24. [Google Scholar] [CrossRef] [PubMed]
[14] Hibi, H., Yamada, Y., Kagami, H. and Ueda, M. (2006) Distraction Osteogenesis Assisted by Tissue Engineering in an Irradiated Mandible: A Case Report. The International Journal of Oral & Maxillofacial Implants, 21, 141-147.
[15] Lizio, G., Corinaldesi, G., Pieri, F. and Marchetti, C. (2009) Problems with Dental Implants That Were Placed on Vertically Distracted Fibular Free Flaps after Resection: A Report of Six Cases. British Journal of Oral and Maxillofacial Surgery, 47, 455-460. [Google Scholar] [CrossRef] [PubMed]
[16] 张陈平, 刘剑楠. 数字化牙种植牵引技术在下颌骨重建中的临床应用要点[J]. 中华口腔医学杂志, 2022, 57(12): 1189-1194.
[17] Chana, J.S., Chang, Y., Wei, F., Shen, Y., Chan, C., Lin, H., et al. (2004) Segmental Mandibulectomy and Immediate Free Fibula Osteoseptocutaneous Flap Reconstruction with Endosteal Implants: An Ideal Treatment Method for Mandibular Ameloblastoma. Plastic and Reconstructive Surgery, 113, 80-87. [Google Scholar] [CrossRef] [PubMed]
[18] Shen, Y., Rodriguez, E.D., Wei, F., Tsai, C. and Chang, Y. (2015) Aesthetic and Functional Mandibular Reconstruction with Immediate Dental Implants in a Free Fibular Flap and a Low-Profile Reconstruction Plate. Annals of Plastic Surgery, 74, 442-446. [Google Scholar] [CrossRef] [PubMed]
[19] Chang, Y., Santamaria, E., Wei, F., Chen, H., Chan, C., Shen, Y., et al. (1998) Primary Insertion of Osseointegrated Dental Implants into Fibula Osteoseptocutaneous Free Flap for Mandible Reconstruction. Plastic & Reconstructive Surgery, 102, 680-688. [Google Scholar] [CrossRef] [PubMed]
[20] Chang, Y., Wallace, C.G., Tsai, C., Shen, Y., Hsu, Y. and Wei, F. (2011) Dental Implant Outcome after Primary Implantation into Double-Barreled Fibula Osteoseptocutaneous Free Flap-Reconstructed Mandible. Plastic and Reconstructive Surgery, 128, 1220-1228. [Google Scholar] [CrossRef] [PubMed]
[21] Wei, F., Celik, N., Yang, W., Chen, I., Chang, Y. and Chen, H. (2003) Complications after Reconstruction by Plate and Soft-Tissue Free Flap in Composite Mandibular Defects and Secondary Salvage Reconstruction with Osteocutaneous Flap. Plastic and Reconstructive Surgery, 112, 37-42. [Google Scholar] [CrossRef] [PubMed]
[22] Smolka, K., Kraehenbuehl, M., Eggensperger, N., Hallermann, W., Thoren, H., Iizuka, T., et al. (2008) Fibula Free Flap Reconstruction of the Mandible in Cancer Patients: Evaluation of a Combined Surgical and Prosthodontic Treatment Concept. Oral Oncology, 44, 571-581. [Google Scholar] [CrossRef] [PubMed]
[23] Navarro Cuéllar, C., Ochandiano Caicoya, S., Navarro Cuéllar, I., Valladares Pérez, S., Fariña Sirandoni, R., Antúnez-Conde, R., et al. (2020) Vertical Ridge Augmentation of Fibula Flap in Mandibular Reconstruction: A Comparison between Vertical Distraction, Double-Barrel Flap and Iliac Crest Graft. Journal of Clinical Medicine, 10, Article 101. [Google Scholar] [CrossRef] [PubMed]
[24] Lee, J.H., Kim, M.J., Choi, W.S., Yoon, P.Y., Ahn, K.M., Myung, H., et al. (2004) Concomitant Reconstruction of Mandibular Basal and Alveolar Bone with a Free Fibular Flap. International Journal of Oral and Maxillofacial Surgery, 33, 150-156. [Google Scholar] [CrossRef] [PubMed]
[25] Wang, E. and Estrella, E. (2016) A Comparison of Vascularized Free Fibular Flaps and Nonvascularized Fibular Grafts for Reconstruction of Long Bone Defects after Tumor Resection. Journal of Reconstructive Microsurgery, 33, 194-205. [Google Scholar] [CrossRef] [PubMed]
[26] Wang, W., Zhu, J., Xu, B., Xia, B., Liu, Y. and Shao, S. (2019) Reconstruction of Mandibular Defects Using Vascularized Fibular Osteomyocutaneous Flap Combined with Nonvascularized Fibular Flap. Medicina Oral Patología Oral y Cirugia Bucal, 24, e691-e697. [Google Scholar] [CrossRef] [PubMed]
[27] 董刚, 徐欣, 郑建金, 等. 髂骨重建下颌并种植修复的临床解剖研究[J]. 中华口腔医学杂志, 2013, 48(2): 102-104.
[28] 中华口腔医学会口腔颌面修复专业委员会. 下颌骨缺损修复重建治疗专家共识[J]. 中华口腔医学杂志, 2019, 54(7): 433-439.
[29] Ferretti, C., Premviyasa, V., Reyneke, J. and Ripamonti, U. (2019) A Mass Guide for the Harvest of Cortico-Cancellous Bone from the Posterior Iliac Crest for Mandibular Reconstruction. British Journal of Oral and Maxillofacial Surgery, 57, 627-631. [Google Scholar] [CrossRef] [PubMed]
[30] Sethi, A., Kaus, T., Cawood, J.I., Plaha, H., Boscoe, M. and Sochor, P. (2020) Onlay Bone Grafts from Iliac Crest: A Retrospective Analysis. International Journal of Oral and Maxillofacial Surgery, 49, 264-271. [Google Scholar] [CrossRef] [PubMed]
[31] Mazzoni, S., Marchetti, C., Sgarzani, R., Cipriani, R., Scotti, R. and Ciocca, L. (2013) Prosthetically Guided Maxillofacial Surgery: Evaluation of the Accuracy of a Surgical Guide and Custom-Made Bone Plate in Oncology Patients after Mandibular Reconstruction. Plastic & Reconstructive Surgery, 131, 1376-1385. [Google Scholar] [CrossRef] [PubMed]
[32] 牛露菡, 赵婷婷, 滕伟. 颌骨缺损自体血管化移植骨种植修复的研究进展[J]. 中华口腔医学杂志, 2023, 58(5): 484-489.

为你推荐