背景：由于软组织缺损和高并发症风险，由战斗损伤引起的下颌骨缺损的重建对于临床医生而言具有挑战性。这项研究评估了使用非血管化the骨移植物（NVICG）重建战斗损伤患者下颌骨连续缺损的结果。
方法：通过高速剂获得的连续下颌骨缺损患者，接受或不接受无微血管软组织或局部皮瓣的NVICG重建的患者，包括在研究中。结果变量是由于术后并发症或完全（超过90％）吸收引起的移植物丢失。主要预测变量是受管区的软组织缺损。次要预测变量是缺损的长度。与患者相关的变量，缺陷部位,手术,和其他并发症也进行了评估。采用独立样本t检验进行统计分析。Pearson的卡方检验和Fisher的精确检验，显著性水平为P<0.05。结果：该研究包括24例患者，27例下颌骨缺损。总的来说,重建的总成功率为59.3%。软组织缺损与移植失败及其他并发症显著相关(p<0.05),主要与软组织缺损有关。即使在较小的软组织缺损中，移植成功率也仅为14.3％。反过来,在有足够软组织覆盖的重建中，75.0%的移植物存活。此外,重建延迟较多的患者移植失败明显少于早期手术的患者(p<0.05).在缺损大小和并发症之间没有发现关联。
结论：足够的软组织覆盖对于重建由战斗损伤引起的下颌骨缺损至关重要。此外，较小的软组织缺损应该用软组织皮瓣覆盖，以避免这些特定损伤的并发症和移植物丢失。如果软组织覆盖足够，甚至可以用NIVICG重建大的缺陷。
BACKGROUND: Reconstruction of mandibular defects caused by combat injuries is challenging for clinicians due to soft tissue defects and high complication risk. This
study evaluated the outcomes of mandibular continuous defects reconstruction with non-vascularized iliac crest graft (NVICG) in patients with combat injuries.
METHODS: Patients with continuous mandibular defects acquired by high-velocity agents, who received NVICG reconstruction with or without microvascular-free soft tissue or regional flaps, were included in the
study. The outcome variable was graft loss due to postoperative complications or full (more than 90 %) resorption. The primary predictor variable was soft tissue defect in the recipient area. The secondary predictor variable was the length of the defect. Variables related to patients, defect site, surgery, and other complications were also evaluated. Statistical analysis was performed with the usage of independent sample t-test, Pearson\'s chi-squared and Fisher\'s exact tests with a significance level of P < 0.05 RESULTS: The
study included 24 patients with 27 mandibular defects. Overall, the general success rate of reconstructions was 59.3 %. Soft tissue defects were significantly associated with graft failure and other complications (p < 0.05), which were mostly related to soft tissue defects. The graft success rate was only 14.3 % even in minor soft tissue defects. In turn, in reconstructions with sufficient soft tissue coverage, the graft survived in 75.0 % of the cases. In addition, patients with more delayed reconstruction had significantly fewer graft failures than those with earlier surgery (p < 0.05). No associations were found between defect size and complications.
CONCLUSIONS: The sufficient soft tissue coverage is essential in the reconstruction of mandibular defects caused by combat injuries. Also, minor soft tissue defects should be covered with soft tissue flaps to avoid complications and graft loss in these specific injuries. Even large defects can be reconstructed with NIVICG if the soft tissue coverage is sufficient.
