CAJ | 학술논문

目的探讨游离前臂皮瓣联合游离髂骨进行口底及面下部复合型组织缺损同期修复重建的临床疗效。方法术前对11例口底及面下部复合型组织缺损的范围及外形进行认真的评估，设计出与缺损区相匹配的个体化前臂皮瓣。术中先行成型钛板恢复缺损下颌骨基本的外形及咬合关系，然后用来复锯切取设计塑型的游离髂骨并移植固定于钛板的内侧，从而恢复缺损下颌骨的连续性。结果 11例前臂皮瓣及髂骨全部成活，成功率100％。本组患者经随访6～ 12个月，修复区外形虽显不同程度的臃肿，但饮食、吞咽等口腔功能得到了改善，有7例可进普食，有4例可进流质饮食，同时可参与社会活动中日常的语言交流，皮瓣的感觉功能及外形恢复满意。结论适形游离前臂皮瓣联合游离髂骨对口底及面下部复合型组织缺损同期修复重建，是修复口底及面下部复合型组织缺损较为理想的方法之一，既达到安全、实用的预后效果，又可明显提高患者的生存质量，值得临床借鉴并使用。
목적 탐토유리전비피판연합유리가골진행구저급면하부복합형조직결손동기수복중건적림상료효。 방법 술전대11례구저급면하부복합형조직결손적범위급외형진행인진적평고，설계출여결손구상필배적개체화전비피판。술중선행성형태판회복결손하합골기본적외형급교합관계，연후용래복거절취설계소형적유리가골병이식고정우태판적내측，종이회복결손하합골적련속성。 결과 11례전비피판급가골전부성활，성공솔100％。본조환자경수방6～ 12개월，수복구외형수현불동정도적옹종，단음식、탄인등구강공능득도료개선，유7례가진보식，유4례가진류질음식，동시가삼여사회활동중일상적어언교류，피판적감각공능급외형회복만의。 결론 괄형유리전비피판연합유리가골대구저급면하부복합형조직결손동기수복중건，시수복구저급면하부복합형조직결손교위이상적방법지일，기체도안전、실용적예후효과，우가명현제고환자적생존질량，치득림상차감병사용。
Objective To probe into the clinical efficiency of reconstruction to person who had composite tissue defect of the floor of mouth and the lower part of face with the free forearm flap and free iliac bone in the same term. Methods Before the surgery, the surgeon should carefully evaluate the scope and shape of defects in 11 cases who had the composite tissue defects of the floor of mouth and the lower part of face, to design the individual forearm flap, so that it matches with the defect region. During surgery, the first resumption of defects using titanium plates forming the basic shape of mandible and the occlusal relationship, then used to re-sawing to take modeling of the iliac bone, transplanted free iliac bone and fixed after the inside of the titanium plate, thereby restoring the continuity of mandible missing. Results Free forearm flap and free iliac bone all survived in 11 cases, the success rate of 100％. The patients were followed up for 6 to 12 months, although the shape of restoration areas were different levels of fat, but eating, swallowing and other oral function had been well improved, 7/11 could enter normal diet, 4/11 to enter liquid diet, At the same time, the patients in social activities can communicate in a language daily, sensory function of skin flap and facial appearance has been satisfactory recovery. Conclusion Conformal free forearm flap and free iliac bone is an ideal way to reconstruct the composite tissue defects of the floor of mouth and the lower part of face in the same period, not only safe, practical prognostic effect, and also can significantly improve the patients quality of life, which is worthy of reference and use.