【作者】 左良；

【导师】 吴汉江；

【作者基本信息】 中南大学 ， 口腔临床医学， 2011， 硕士

【摘要】 目的探讨口内入路切除下颌骨良性肿瘤游离髂骨移植重建术后髁突位置及骨高度的动态变化。方法收集2006年6月-2010年4月因下颌骨良性肿瘤收入湘雅二医院口腔颌面外科病房住院手术的患者共20例,手术方式均为口内入路切除下颌骨良性肿瘤游离髂骨移植重建,按照是否保留髁突分为A、B两组,按照游离髂骨是否分段移植分为C、D两组,收集患者术前,术后一周-12个月的曲面体层片,通过对患者术后各个时间点曲面体层片中游离骨的骨高度及颞下颌关节间隙的测量(张震康法和Kamelchuk法),研究其髁突位置及骨高度的动态变化。结果1、A组患侧和健侧术前与术后的关节前、上、后间隙的差异均无统计学意义(p＞0.05),关节间隙线性百分比的差异均无统计学意义(p>0.05),A组患侧和健侧术后髁突位置居中。2、B组患侧术前与术后的关节前、后间隙的差异有统计学意义(p<0.05),B组患侧术前与术后的关节间隙线性百分比的差异有统计学意义(p＜0.05),B组患侧术后髁突位置前移。3、A组在术后3个月、术后6个月、术后12个月升支游离骼骨骨高度的吸收率分别为1.8%,3.2%和4.3%,升支游离髂骨骨高度有较小程度的降低。4、B组在术后3个月、术后6个月、术后12个月升支游离髂骨骨高度的吸收率分别为7.9%,19.8%和34.7%,升支游离髂骨骨高度降低的幅度较大。5、C组与D组在0-3月,0-6月和0-12月三个位点的平均吸收率差别不大,D组比C组略高0.8%-4.7%,D组的B点和B’点的吸收率明显高于C组,达到4%-16.5%。结论1、保留髁突的游离髂骨移植,其患侧和健侧髁突位置均无明显改变；未保留髁突的游离髂骨移植,健侧髁突位置前移。2、游离髂骨分段移植与整块移植相比,其两块移植骨相接处吸收率较高。3、保留髁突的游离髂骨移植能够保持升支移植骨高度。4、口内入路与口外入路的游离髂骨移植,其移植骨吸收率无明显差别。更多还原

【Abstract】 ObjectiveTo investigate the change of the position of condylar process and the height of bone grafts in benign mandibular tumor resection with intra-oral route and immediate reconstruction by non-vascularized iliac bone grafts.MethodsIn this article,20 patients admitted to the Department of Oral and Maxillofacial Surgery, Second Xiangya Hospital of Central South University for benign mandibular tumor were followed from June 2006 to April 2010. All of them were treated with benign mandibular tumor resection via intra-oral route and immediate reconstruction by non-vascularized iliac bone grafts. We divided them into groups according to the preservation of condylar process and the blocks of free autogenous iliac bone. We measured the height of free autogenous iliac bone and the joint space by panoramic radiographs to discuss the the change of the position of condylar process and the height of free autogenous iliac bone in benign mandibular tumor resection with intra-oral route and immediate reconstruction by non-vascularized iliac bone grafts.Results1. The linear distances of TMJ space showed no significant differences (p>0.05), and it was not statistically significant (p>0.05) on the ration between anterior TMJ and posterior TMJ linear distances before and after operation in group A.2. It was statistically significant (p<0.05) on the linear distances of TMJ space, and the ration between anterior TMJ and posterior TMJ linear distances showed significant differences (p<0.05) before and after operation in group B.3. The absorption rate of bone grafts of ramus 3 months,6months and 12 months after operation was 1.8%,3.2% and 4.3% in group A.4. There was obvious reduction in group B. The absorption rate of bone grafts of ramus 3 months,6months and 12 months after operation was 7.9%,19.8% and 34.7%.5. The average absorption rate of the bone grafts showed no significant difference between group C and group D 3 months,6months and 12 months after operation. The rate was 0.8%-4.7% more in group D. The B and B’spot of bone grafts were absorbed much heavier in group D, and the rate was 4%-16.5% more than in group C.Conclusion1. The position of condylar process showed no change in the condyles reserved cases, while the condylar process of the normal side moved forward in the condyles removed cases after operation.2. Comparing with one bone graft, the absorption rate was higher in the position of two bone grafts contacted。3. The preservation of condylar process can keep the height the bone grafts.4. The average absorption rate of the bone grafts showed no significant differences between the operation with intra-oral route and the outside route.更多还原