游离组织瓣修复颌面部缺损后血管蒂骨化的发生率及影响因素的系统评价

doi:10.12439/kqhm.1005-4979.2023.06.004

摘要/Abstract

摘要：

目的：综合分析游离组织瓣修复颌面部缺损后血管蒂异位骨化的发生率及其影响因素。方法：检索PubMed、Web of Science、中国知网数据库（CNKI），关键词为“pedicle ossification”“free flap”“maxillofacial ”，检索时间为2000年1月1日至2021年12月1日的有关游离组织瓣血管蒂异位骨化的文献，采用RevMan 5.4软件进行meta分析。结果：纳入文献5篇，共计病例829例。影像学上可见的血管蒂异位骨化发生率约为11%；有临床症状的发生率约为2%。合并比值比显示，血管蒂异位骨化的发生与组织瓣类型有显著相关性（OR=14.01，95%CI=3.58~54.85，P<0.001），但其与性别（OR=1.63，95%CI=1.00~2.67，P=0.05）、重建部位（OR=0.90，95%CI=0.46~1.74，P>0.05）、是否做过放疗（OR=0.79，95%CI=0.52~1.22，P>0.05）无显著相关性。结论：游离组织瓣修复颌面部缺损后，影像学上可见的血管蒂异位骨化发生率约为11%，有临床症状的发生率约为2%。其发生主要与游离组织瓣的类型有关，多好发于游离腓骨瓣。

关键词: 游离皮瓣, 腓骨瓣, 血管蒂骨化, 修复重建, 颌骨缺损

Abstract:

Objective: To analyze the incidence and influencing factors of vascular pedicle ossification after the repair of maxillofacial defects by free flap. Methods: Search PubMed, Web of Science and CNKI databases for keywords "pedicle ossification", "free flap" and "maxillofacial". The literatures on heterotopic ossification of free flap vascular pedicle from January 1, 2000 to December 1, 2021 were obtained. RevMan 5.4 software was used for meta analysis. Results: Five literatures were included, consisting of 829 cases in total. The incidence of heterotopic ossification of vascular pedicle visible on imaging examinations was about 11%, and the incidence of ossification with clinical symptoms was about 2%. The combined odds ratio showed that the occurrence of heterotopic ossification of vascular pedicle was significantly correlated with flap type (OR=14.01, 95%CI=3.58-54.85, P<0.001), but not with gender (OR=1.63, 95%CI=1.00-2.67, P=0.05), site of reconstruction（OR=0.90, 95%CI=0.46-1.74, P>0.05), or whether radiotherapy had been performed（OR=0.79, 95%CI=0.52-1.22, P>0.05). Conclusion: After the repair of maxillofacial defects by free flap, the incidence of heterotopic ossification of vascular pedicle visible on imaging examinations was about 11%, and the incidence of ossification with clinical symptoms was about 2%, which was mainly related to the type of free flap and mostly occurred in free fibular flap.

Key words: free flap, fibula flap, vascular pedicle ossification, repair and reconstruction, jaw bone defect

中图分类号:

R782

胡娟. 游离组织瓣修复颌面部缺损后血管蒂骨化的发生率及影响因素的系统评价[J]. 《口腔颌面外科杂志》, 2023, 33(6): 379-384.

HU Juan. Incidence and influencing factors of vascular pedicle ossification after the repair of maxillofacial defects by free flap: A systemic review[J]. 《Journal of Oral and Maxillofacial Surgery》, 2023, 33(6): 379-384.

https://journal06.magtech.org.cn/Jweb_joms/CN/Y2023/V33/I6/379

图/表 4

图1 文献检索流程

Figure 1 Flow chart of literature retrieval

表1 纳入文献的基本特征

Table 1 Characteristics of included studies

第一作者	年份	国家	研究类型	样本量	结局指标r	NOS评分
Barry F^[3]	2021	法国	回顾性	274	①~⑤	8
Wood CB^[4]	2020	美国	回顾性	217	①，②，④，⑤	7
Knitschke M^[5]	2020	德国	回顾性	102	①~⑤	7
Karagozoglu KH^[6]	2013	荷兰	回顾性	74	①~③，⑤	8
Myon L^[7]	2012	法国	回顾性	162	⑤	6

图2 游离组织瓣修复颌面部缺损术后血管蒂骨化的发生率 A.影像学上可见的骨化发生率；B. 有临床症状的骨化发生率。

Figure 2 The incidence of vascular pedicle ossification after the repair of maxillofacial defects by free flap

图3 血管蒂异位骨化与患者临床特征的相关性 A. 性别；B. 放疗；C. 重建部位；D. 组织瓣类型。

Figure 3 Relationship between heterotopic ossification of vascular pedicle and clinicopathological features of patients

参考文献 21

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