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目的探讨下颌骨大型缺损后,采取腓骨肌皮瓣双叠结合II期种植义齿修复重建患者咬合功能,并评估修复后患者面部外形、咀嚼功能的临床效果。方法对6例因肿瘤切除部分下颌骨而造成下颌骨大型缺损的患者行腓骨肌皮瓣双叠移植术,术前通过CT扫描及Simplant软件重建缺损下颌骨并在计算机上设计和定位腓骨肌皮瓣的塑形位点及进行术前模拟,术后观察1年,无复发者II期通过软件设计种植位点并制作种植导板,辅助种植体植入,种植手术3个月后行义齿修复,定期随访,并测定患者种植义齿咀嚼功能、指导义齿护理。结果 6例游离腓骨肌皮瓣全部成活,1年后无复发,II期种植体植入后与移植骨骨性结合,5例义齿修复后面部外形对称、咬合关系良好、临床效果满意,测定咀嚼效率恢复良好,1例患者义齿修复后2个月磨牙区牙龈出现红肿疼痛,经局部冲洗及抗炎治疗1周后,炎症减轻,2周后牙龈肿胀消除、颜色恢复正常。结论腓骨肌皮瓣双叠结合种植义齿是修复下颌骨大型缺损的可靠方法之一。计算机软件辅助骨缺损及种植修复,可以有效恢复颌面部外形及功能。义齿修复后基托与牙龈之间应保持适当的距离(1.5-2mm),便于义齿清洁。义齿修复后使用牙冲洗器效果良好。
Objective To investigate the clinical effect of reconstructing the occlusal function and reconstructing facial shape and masticatory function in patients with mandibular large defect after repairing and reconstructing the denture with fibula myocutaneous flap combined with the second-stage implant denture. Methods Six patients with maxillary mandibular defect due to tumor resection were performed double-grafting of fibula myocutaneous flap. The mandibular defects were reconstructed by CT scan and Simplant software before operation. The peroneal muscle fibula Flap shaping site and preoperative simulation, postoperative observation of 1 year, no recurrence II stage through the software design of planting sites and the production of planting guide plate, assisted implant implantation, implant surgery 3 months after the denture repair, Regular follow-up, and determination of implant denture chewing function, guide denture care. Results All the 6 cases of free fibula myocutaneous flaps survived and no recurrence occurred after 1 year. The implants of stage II were combined with the bony union of bone grafts. The facial features of the 5 cases were symmetrical and the occlusion was good. The clinical results were satisfactory. The efficiency recovered well. In one patient, the gingiva in the molar area was painful and swollen 2 months after the denture was repaired. After one week of local irrigation and anti-inflammatory treatment, the inflammation was relieved. After 2 weeks, the gingival swelling disappeared and the color returned to normal. Conclusions The double perfused fibular myocutaneous flap combined with implant denture is one of the reliable methods to repair large defects of the mandible. Computer software-assisted bone defects and implant repair, can effectively restore the shape and function of maxillofacial region. Denture repair between the base and the gum should be maintained an appropriate distance (1.5-2mm), easy to denture clean. Denture repair teeth toothbrush good effect.