同期神经化髂骨瓣在下颌骨重建中保存下唇及颏部感觉的效果评价

doi:10.19439/j.sjos.2023.01.010

上海口腔医学 ›› 2023, Vol. 32 ›› Issue (1): 52-57.doi: 10.19439/j.sjos.2023.01.010

同期神经化髂骨瓣在下颌骨重建中保存下唇及颏部感觉的效果评价

史敬存, 吴梓谦, 张于涵, 肖孟, 张士剑, 章臻, 张冰清, 王磊

上海交通大学医学院附属第九人民医院口腔颌面-头颈肿瘤科,上海交通大学口腔医学院, 国家口腔医学中心,国家口腔疾病临床医学研究中心,上海市口腔医学重点实验室, 上海市口腔医学研究所,上海 200011

收稿日期:2022-07-27 修回日期:2022-09-25 出版日期:2023-02-25 发布日期:2023-06-12
通讯作者: 王磊,E-mail: wangleizyh@aliyun.com
作者简介:史敬存（1996-）,男,硕士研究生,E-mail: jingcun_shi@163.com
基金资助:
国家自然科学基金（81970907,81771046）

Evaluation of the effect of simultaneous neuralized iliac bone flap on the preservation of lower lip and chin sensation during mandibular reconstruction

SHI Jing-cun, WU Zi-qian, ZHANG Yu-han, XIAO Meng, ZHANG Shi-jian, ZHANG Zhen, ZHANG Bing-qing, WANG Lei

Department of Oromaxillofacial Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai Research Institute of Stomatology. Shanghai 200011, China

Received:2022-07-27 Revised:2022-09-25 Online:2023-02-25 Published:2023-06-12

摘要/Abstract

摘要： 目的: 评价同期神经化髂骨瓣在修复下颌骨缺损中,重建下牙槽神经,保存下唇及颏部感觉的效果。方法: 对于下颌骨连续性缺损需颌骨重建的患者,通过随机数字表将患者随机分配到神经化组和对照组,神经化组患者在颌骨重建术中吻合旋髂深动静脉与受区血管,并同期吻合支配腹内斜肌及髂骨的髂腹股沟神经与受区的颏神经、下牙槽神经残端;对照组术中只进行血管吻合而不进行神经重建。术中用神经监护仪检测髂骨瓣神经吻合后的神经电活力。术后通过两点辨别觉（two point discrimination, TPD）检查、感觉神经阈值(current perception threshold, CPT)检测及Touch test感觉测试丝 (Touch test sensory evaluator, TTSE)检测记录患者下唇及颏部感觉恢复情况。采用SPSS 26.0软件包对数据进行统计学分析。结果: 共纳入20例患者,每组各10例,2组髂骨瓣存活率均为100%,未发生皮瓣危象等严重并发症,供区无明显并发症。TPD检测、CPT测试及TTSE检测结果均提示,神经化组术后感觉减退程度更小（P<0.05）。结论: “环路重构”式同期神经吻合血管化髂骨瓣可有效保留下唇感觉,提升患者术后生活质量,是一种安全有效的重建方法。

关键词: 神经吻合, 髂骨瓣, 感觉, 下颌骨缺损, 颌骨重建

Abstract: PURPOSE: To evaluate the effect of reconstructing inferior alveolar nerve and preserving the sensation of lower lip and chin in repairing mandibular defect by simultaneous neuralized iliac bone flap. METHODS: Patients with continuous mandibular defects requiring reconstruction were randomly assigned to the innervated(IN) group and the control(CO) group by random number table. In the IN group, the deep circumflex iliac artery and recipient vessels were anastomosed microscopically during mandible reconstruction, and the ilioinguinal nerve(IN), mental nerve(MN) and inferior alveolar nerve(IAN) were anastomosed at the same time. In the CO group, only vascular anastomosis was performed without nerve reconstruction. During the operation, the nerve electrical activity after nerve anastomosis was detected by nerve monitor, and the sensory recovery of lower lip was recorded by two-point discrimination(TPD), current perception threshold (CPT) and Touch test sensory evaluator(TTSE) test. SPSS 26.0 software package was used for data analysis. RESULTS: According to the inclusion and exclusion criteria, a total of 20 patients were included, with 10 patients in each group. All the flaps survived in both groups, and no serious complications such as flap crisis occurred, and no obvious complications occurred in the donor site. The results of TPD test, CPT test and TTSE test all indicated that the degree of postoperative hypoesthesia in the IN group was less(P<0.05). CONCLUSIONS: Simultaneous nerve anastomosis vascularized iliac bone flap can effectively preserve the feeling of lower lip and improve the postoperative quality of life of patients. It is a safe and effective technique.

Key words: Neurorrhaphy, Iliac bone flap, Sensatation, Mandible defect, Mandible reconstruction

中图分类号:

R782.2

史敬存, 吴梓谦, 张于涵, 肖孟, 张士剑, 章臻, 张冰清, 王磊. 同期神经化髂骨瓣在下颌骨重建中保存下唇及颏部感觉的效果评价[J]. 上海口腔医学, 2023, 32(1): 52-57.

SHI Jing-cun, WU Zi-qian, ZHANG Yu-han, XIAO Meng, ZHANG Shi-jian, ZHANG Zhen, ZHANG Bing-qing, WANG Lei. Evaluation of the effect of simultaneous neuralized iliac bone flap on the preservation of lower lip and chin sensation during mandibular reconstruction[J]. Shanghai Journal of Stomatology, 2023, 32(1): 52-57.

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同期神经化髂骨瓣在下颌骨重建中保存下唇及颏部感觉的效果评价

Evaluation of the effect of simultaneous neuralized iliac bone flap on the preservation of lower lip and chin sensation during mandibular reconstruction

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