功能优先的新型下颌骨缺损分类（COM）法及临床应用

doi:10.19438/j.cjoms.2019.01.001

中国口腔颌面外科杂志 ›› 2019, Vol. 17 ›› Issue (1): 1-6.doi: 10.19438/j.cjoms.2019.01.001

功能优先的新型下颌骨缺损分类（COM）法及临床应用

张陈平^*, 阮敏^*, 刘剑楠, 杨溪, 李思毅, 曲行舟, 季彤

上海交通大学医学院附属第九人民医院·口腔医学院口腔颌面-头颈肿瘤科, 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:2018-12-18 修回日期:2019-01-02 出版日期:2019-01-20 发布日期:2019-02-21
通讯作者: 张陈平,E-mail：doc_zcp@163.com
作者简介:张陈平（1959-）,男,教授、博士研究生导师;阮敏（1978-）,男,副教授、硕士研究生导师,E-mail：doctorruanmin@126.com。^*并列第一作者
基金资助:
科技创新专项基金（ZH20182DA15）

Functionally superior new classification of mandibular defects (COM) and its clinical application

ZHANG Chen-ping, RUAN Min, LIU Jian-nan, YANG Xi, LI Si-yi, QU Xing-zhou,JI Tong

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

Received:2018-12-18 Revised:2019-01-02 Online:2019-01-20 Published:2019-02-21

摘要/Abstract

摘要： 下颌骨缺损多由良恶性肿瘤切除、创伤和感染所致,会导致患者不同程度的颜面畸形和生理功能障碍。下颌骨缺损具有复杂性,不同部位、范围的缺损,将产生不同程度的形态和功能损害,相应的修复重建难度也不相同。因此,下颌骨缺损的精准分类对功能性重建及术后康复意义重大。本文在前期大量临床实践基础上提出了新的基于髁区（condyle region）、区（occlusion region）和肌区（muscle region）3大不同功能区域的新型下颌骨缺损分类方法,即COM法,希望有助于下颌骨的功能性修复重建指导及康复效果预测。

关键词: 下颌骨缺损, 分类, COM法

Abstract: Mandibular defects are mostly caused by resection of benign and malignant tumors, trauma and infection, which can lead to different degrees of facial deformity and physiological dysfunction. Mandibular defects are complex, and different parts and ranges of defects will produce different degrees of morphological and functional damage, and the subsequent repair and reconstruction difficulties are also different. Therefore, accurate classification of mandibular defects is of great significance for functional reconstruction and postoperative rehabilitation. Based on a large number of previous clinical practices, this paper proposed a new classification method for mandibular defects based on three different functional areas: condyle region, occlusion region and muscle region, namely COM method. It is elaborated here and hopes to help repair guidance and prediction of rehabilitation effects.

Key words: Mandibular defect, Classification, COM method

中图分类号:

R782.2.3

张陈平, 阮敏, 刘剑楠, 杨溪, 李思毅, 曲行舟, 季彤. 功能优先的新型下颌骨缺损分类（COM）法及临床应用[J]. 中国口腔颌面外科杂志, 2019, 17(1): 1-6.

ZHANG Chen-ping, RUAN Min, LIU Jian-nan, YANG Xi, LI Si-yi, QU Xing-zhou,JI Tong. Functionally superior new classification of mandibular defects (COM) and its clinical application[J]. China J Oral Maxillofac Surg, 2019, 17(1): 1-6.

参考文献

[1] Boyd JB, Gullane PJ, Rotstein LE, et al.Classification of mandibular defects[J]. Plast Reconstr Surg, 1993, 92(7): 1266-1275.
[2] Pavlov BL.Classification of mandibular defects[J]. Stomatologiia (Mosk), 1974, 53(5): 43-46.
[3] David DJ, Tan E, Katsaros J, et al.Mandibular reconstruction with vascularized iliac crest: a 10 - year experience[J]. Plast Reconstr Surg, 1988, 82(5): 792-803.
[4] Jewer DD, Boyd JB, Manktelow RT, et al. Orofacial and mandibular reconstruction with the iliac crest free flap: a review of 60 cases and a new method of classification [J]. Plast Reconstr Surg, 1989, 84(3): 391-403, 404-405.
[5] Urken ML, Weinberg H, Vickery C, et al.Oromandibular reconstruction using microvascular composite free flaps. Report of 71 cases and a new classification scheme for bony, soft-tissue, and neurologic defects[J]. Arch Otolaryngol Head Neck Surg, 1991, 117(7): 733-744.
[6] Sakakibara A, Hashikawa K, Yokoo S, et al.Risk factors and surgical refinements of postresective mandibular reconstruction: a retrospective study[J]. Plast Surg Int, 2014, 2014: 893746.
[7] Brown JS, Barry C, Ho M, et al.A new classification for mandibular defects after oncological resection[J]. Lancet Oncol, 2016, 17(1): e23-e30.
[8] 张庆福, 吕春堂. 下颌骨节段性缺损的分类和修复重建[J]. 口腔颌面外科杂志, 2006, 16(3): 270-273.
[9] 李静远, 廖贵清. 下颌骨缺损分类进展[J]. 中华口腔医学研究杂志(电子版), 2017, 11(2): 115-118.
[10] Iizuka T, Hafliger J, Seto I, et al.Oral rehabilitation after mandibular reconstruction using an osteocutaneous fibula free flap with endosseous implants. Factors affecting the functional outcome in patients with oral cancer[J]. Clin Oral Implants Res, 2005, 16(1): 69-79.
[11] Schultz BD, Sosin M, Nam A, et al.Classification of mandible defects and algorithm for microvascular reconstruction[J]. Plast Reconstr Surg, 2015, 135(4): 743e-754e.
[12] 王志平, 吴汉江, 朱兆夫. 下颌骨缺损的外形修复与功能重建[J]. 口腔颌面外科杂志, 2002, 12(1): 61-63.
[13] Zhang C, Ruan M, Xu L, et al.Dental implant distractor combined with free fibular flap: a new design for simultaneous functional mandibular reconstruction[J]. J Oral Maxillofac Surg

[1]	邱银秀, 代天国, 徐波, 程进强, 刘忠龙. 重症口腔颌面头颈部多间隙感染临床分类探讨[J]. 中国口腔颌面外科杂志, 2023, 21(2): 125-130.
[2]	顾雨薇, 王凤, 黄伟, 张志勇, 张陈平, 孙坚, 吴轶群. 种植联合血管化髂骨移植重建14例下颌骨缺损的长期疗效观察[J]. 中国口腔颌面外科杂志, 2022, 20(5): 422-428.
[3]	顾雨薇, 王凤, 黄伟, 张志勇, 张陈平, 孙坚, 吴轶群. 种植联合血管化髂骨移植重建14例下颌骨缺损的长期疗效观察[J]. 中国口腔颌面外科杂志, 2022, 20(5): 488-493.
[4]	杨宗燕, 康一帆, 吕晓鸣, 张雷, 单小峰, 蔡志刚. 血管化髂骨瓣重建下颌骨有牙区缺损时髂骨嵴不同朝向的优缺点比较[J]. 中国口腔颌面外科杂志, 2021, 19(5): 434-438.
[5]	徐晓峰, 朱方兴, 廖倩, 徐兵, 沈国芳, 张文斌, 史俊. 75例下颌骨粉碎性骨折的治疗效果评价[J]. 中国口腔颌面外科杂志, 2021, 19(5): 456-459.
[6]	林钊宇, 周斌, 陈伟良, 汪延, 陈睿, 钟江龙. 斜方肌肌皮瓣联合肩胛骨肌皮瓣修复晚期头颈肿瘤术后下颌骨贯穿性缺损6例报道[J]. 中国口腔颌面外科杂志, 2020, 18(5): 447-450.
[7]	宋昊天, 杨驰. 45例复发性颞下颌关节前脱位的分类及治疗探讨[J]. 中国口腔颌面外科杂志, 2019, 17(4): 352-355.
[8]	李晨琳, 徐光宙, 杨驰, 汪湧. 下颌阻生第三磨牙阻生类型与第二磨牙损害相关性的影像分析[J]. 中国口腔颌面外科杂志, 2018, 16(4): 357-361.
[9]	韩孜祥, 陈敏洁, 杨驰, 魏文斌, 石慧敏. 171例颞下颌关节滑膜软骨瘤病MRI分析[J]. 中国口腔颌面外科杂志, 2017, 15(1): 16-19.
[10]	韩孜祥, 陈敏洁, 杨驰, 魏文斌, 石慧敏. 171例颞下颌关节滑膜软骨瘤病MRI分析[J]. 中国口腔颌面外科杂志, 2017, 15(1): 41-45.
[11]	韩孜祥, 陈敏洁, 杨驰, 魏文斌, 石慧敏. 171例颞下颌关节滑膜软骨瘤病MRI分析[J]. 中国口腔颌面外科杂志, 2017, 15(1): 46-50.
[12]	苏佳楠, 徐晓峰, 徐兵. 70例颧上颌复合体骨折类型与眶下神经损伤的相关分析[J]. 中国口腔颌面外科杂志, 2017, 15(1): 56-58.
[13]	李永平, 罗秀娟, 袁晓琴, 郭建姝, 郭蕾, 文志春. 68 例髁突骨折临床分析[J]. 中国口腔颌面外科杂志, 2016, 14(3): 253-256.
[14]	王友元, 张大明, 钟江龙, 范松, 林钊宇, 房思炼, 陈伟良. 延长下斜方肌肌皮瓣修复下颌骨钛板外露的疗效观察[J]. 中国口腔颌面外科杂志, 2016, 14(2): 167-171.
[15]	周斌, 庄秀妹, 陈伟良, 王友元, 张大明, 范松, 黄志权. 支架植入治疗颈动脉体瘤术后继发假性动脉瘤的临床分析[J]. 中国口腔颌面外科杂志, 2015, 13(3): 253-257.

功能优先的新型下颌骨缺损分类（COM）法及临床应用

Functionally superior new classification of mandibular defects (COM) and its clinical application

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价