Abstract：
OBJECTIVE: Mandibular plate reconstruction (MPR) is often indicated after tumor ablation, osteoradionecrosis excision, and traumatic bone loss to restore oral functionality and facial cosmetics. There are limited analyses identifying risk factors that lead to plate infection (PIn), exposure, and removal (\"plate complications\").
METHODS: Retrospective cohort study.
METHODS: Academic tertiary medical center.
METHODS: Patients who underwent MPR from 2013 to 2022 were identified. Risk factors for plate complications were analyzed based on demographic, clinical, intraoperative, and postoperative factors. Multivariable analysis was conducted with logistic regression. Survival analysis was conducted with a Cox model.
RESULTS: Of the 188 patients analyzed, 48 (25.5%) had a plate complication [infection: 22 (11.7%); exposure: 23 (12.2%); removal: 35 (18.6%)]. Multivariate analysis revealed predictive associations between at least 1 plate complication and the following variables: smoking status, soft tissue defect size, number of plates, average screw length, and various postoperative complications. Other associations approached the threshold for significance. Prior and adjuvant radiation therapy, type of free flap, stock versus custom plates, and perioperative antibiotic prophylaxis regimens were not associated with plate complications. No plate complication was independently associated with lower overall survival. PIn (hazard ratio, HR: 7.99, confidence interval, CI [4.11, 15.54]) and exposure (HR: 3.56, CI [1.79, 7.08]) were independently associated with higher rates of plate removal.
CONCLUSIONS: Plate complications are relatively common after MPR. Smoking history, specific disease characteristics, hardware used during surgery, and postoperative complications may help identify higher-risk patients, but additional larger-scale studies are needed to validate our findings and resolve discrepancies in the current literature.
METHODS: Retrospective cohort study.
METHODS: Academic tertiary medical center.
METHODS: Patients who underwent MPR from 2013 to 2022 were identified. Risk factors for plate complications were analyzed based on demographic, clinical, intraoperative, and postoperative factors. Multivariable analysis was conducted with logistic regression. Survival analysis was conducted with a Cox model.
RESULTS: Of the 188 patients analyzed, 48 (25.5%) had a plate complication [infection: 22 (11.7%); exposure: 23 (12.2%); removal: 35 (18.6%)]. Multivariate analysis revealed predictive associations between at least 1 plate complication and the following variables: smoking status, soft tissue defect size, number of plates, average screw length, and various postoperative complications. Other associations approached the threshold for significance. Prior and adjuvant radiation therapy, type of free flap, stock versus custom plates, and perioperative antibiotic prophylaxis regimens were not associated with plate complications. No plate complication was independently associated with lower overall survival. PIn (hazard ratio, HR: 7.99, confidence interval, CI [4.11, 15.54]) and exposure (HR: 3.56, CI [1.79, 7.08]) were independently associated with higher rates of plate removal.
CONCLUSIONS: Plate complications are relatively common after MPR. Smoking history, specific disease characteristics, hardware used during surgery, and postoperative complications may help identify higher-risk patients, but additional larger-scale studies are needed to validate our findings and resolve discrepancies in the current literature.
摘要：
目的：下颌钢板重建术（MPR）常应用于肿瘤消融后，骨坏死切除术，和创伤性骨质流失，以恢复口腔功能和面部化妆品。确定导致钢板感染(PIn)的危险因素的分析有限，暴露,和移除(“钢板并发症”)。
方法：回顾性队列研究。
方法：学术三级医疗中心。
方法：确定了2013年至2022年接受MPR的患者。钢板并发症的危险因素分析基于人口学，临床,术中,和术后因素。采用logistic回归进行多变量分析。用Cox模型进行生存分析。
结果：在分析的188例患者中，48（25.5％）有钢板并发症[感染：22（11.7％）;暴露：23（12.2％）;切除：35（18.6％）]。多变量分析显示至少1个钢板并发症与以下变量之间的预测性关联：吸烟状况，软组织缺损大小,板的数量,平均螺钉长度,以及各种术后并发症。其他关联接近显著性的阈值。事先和辅助放射治疗，自由皮瓣的类型，股票与定制板，围手术期抗生素预防方案与钢板并发症无关。无钢板并发症与较低的总生存率独立相关。引脚(危险比，HR：7.99，置信区间，CI[4.11，15.54]）和暴露（HR：3.56，CI[1.79，7.08]）与较高的平板移除率独立相关。
结论：MPR术后钢板并发症比较常见。吸烟史,特定的疾病特征，手术过程中使用的硬件，术后并发症可能有助于识别高危患者，但需要更多更大规模的研究来验证我们的研究结果并解决当前文献中的差异.
方法：回顾性队列研究。
方法：学术三级医疗中心。
方法：确定了2013年至2022年接受MPR的患者。钢板并发症的危险因素分析基于人口学，临床,术中,和术后因素。采用logistic回归进行多变量分析。用Cox模型进行生存分析。
结果：在分析的188例患者中，48（25.5％）有钢板并发症[感染：22（11.7％）;暴露：23（12.2％）;切除：35（18.6％）]。多变量分析显示至少1个钢板并发症与以下变量之间的预测性关联：吸烟状况，软组织缺损大小,板的数量,平均螺钉长度,以及各种术后并发症。其他关联接近显著性的阈值。事先和辅助放射治疗，自由皮瓣的类型，股票与定制板，围手术期抗生素预防方案与钢板并发症无关。无钢板并发症与较低的总生存率独立相关。引脚(危险比，HR：7.99，置信区间，CI[4.11，15.54]）和暴露（HR：3.56，CI[1.79，7.08]）与较高的平板移除率独立相关。
结论：MPR术后钢板并发症比较常见。吸烟史,特定的疾病特征，手术过程中使用的硬件，术后并发症可能有助于识别高危患者，但需要更多更大规模的研究来验证我们的研究结果并解决当前文献中的差异.
