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目的：探讨腓骨游离瓣同期修复下颌骨缺损过程中骨段的塑形与固定方法。方法：作者自１９９６年４月以来连续应用腓骨游离瓣修复口腔下颌骨缺损２６例。依下颌骨缺损范围，将缺损分为八种类型。根据每类缺损部位及特点，对修复骨瓣进行截开、分段，参照正常下颌骨解剖形态对骨段塑形，分别用微型钛板，修复钛板，记忆合金骑缝钉或２０号不锈钢丝进行固定。结果：所有骨瓣及骨皮瓣均存活，成功率１００％。２６例下颌骨缺损中Ⅰ类缺损４例，Ⅱ类４例，Ⅲ类４例，Ⅳ类５例，Ⅴ类２例，Ⅵ类３例，Ⅶ类３例，Ⅷ类１例。骨瓣截成４段者１例，３段者６例，２段者１４例，剩余５例未分段。术后３个月摄片示仅１例分成３段者最短骨段有轻度吸收，其余骨段愈合良好。术后面形恢复优良率达８５％（２２／２６）。结论：腓骨游离瓣可截成２～４段。截骨部位应选择在正中联合，颏体交界处和下颌角处。修复正中联合缺损时以选用小型钛板固定为宜，二段以上的骨瓣或修复升支缺损时，应选用修复钛板进行固定，钢丝结扎仅用于辅助固定，记忆合金骑缝钉适用于骨瓣与髁突的固定
Objective: To discuss the method of shaping and fixing bone segments during the repair of mandibular defects with fibular free flap. Methods: The authors used continuous fibular free flap to repair oral mandibular defect in 26 cases since April 1996. According to the scope of mandibular defects, the defects are divided into eight types. According to each type of defect site and characteristics, the prosthetic bone flap was cut and segmented, and the anatomical shape of the normal mandible was used to shape the bone segment. Micro titanium plate, titanium plate, memory alloy staple or stainless steel wire 20 Fixed. Results: All the bone flap and bone flap survived with a success rate of 100%. There were 4 type Ⅱ defects in the mandibular defects, 4 in type Ⅱ, 4 in type Ⅲ, 5 in type Ⅳ, 2 in type Ⅴ, 3 in Ⅵ, 3 in Ⅶ and 1 in Ⅷ. There were 1 case with 4 segments of the flap, 6 cases with 3 segments, 14 cases with 2 segments and the remaining 5 cases without segment. 3 months after radiography showed only 1 case was divided into 3 segments of the shortest bone segments with mild absorption, the rest of the bone segments healed well. The excellent rate of postoperative reconstruction was 85% (22/26). Conclusion: The fibula free flap can be cut into 2 ~ 4 segments. Osteotomy should be selected in the median joint, chin junction and mandibular angle Department. Repair of the median joint defect in the selection of small titanium plate is appropriate, more than two sections of the flap or repair lumbar prosthesis should be used to fix the titanium plate, wire ligation only for the auxiliary fixation, memory alloy staples for bone Flap and condyle fixation