放射性骨坏死 (ORN) 是头颈癌的一种侵袭性后遗症，其治疗重点是功能恢复和生活质量 (QoL)。本研究旨在识别 ORN 重建中生活质量不佳的风险，并建立按时间顺序排列的纵向生活质量框架。高级作者对 2015 年至 2023 年期间进行的重建前瞻性数据库进行了审查。术前、术后一年和每年随访均前瞻性地进行生活质量指标（华盛顿大学 [UWQoL]v4）。纳入了 56 名 ORN 患者（平均 58.2 年，平均 6,412Gy 辐射）。重建常用腓骨皮瓣（55.4%）和大腿前外侧皮瓣（37.5%）。总并发症率为 23.2%，中位术后 10.7 个月。“与癌症诊断前相比的健康相关生活质量”（62.5 vs 43.5；p=0.030）和“过去 7 天的总体生活质量”（ 50.5 vs 41.7；p=0.029）ORN 重建后比之前更高。癌前重建前的身体生活质量 (79.0) 高于 ORN 重建前 (50.6;p<0.001) 和重建后 (52.5;p=0.001)。与重建前相比，ORN 重建后的社会情感功能更高（68.7 vs 59.6；p=0.010）。在多变量分析中，术后社会情感和身体功能均受到槟榔使用的影响（p=0.038；p=0.010）。 p=0.025）。 ORN 重建前后生活质量改善不佳受到上颌受累 (p=0.048)、瘘管 (p=0.004) 和硬件问题 (p=0.001) 的影响。我们的纵向经验显示 ORN 诊断时生活质量逐渐下降重建后的改善，最终社交情绪、疼痛、焦虑、咀嚼和总体生活质量在手术后显着改善。槟榔是术后生活质量差的危险因素。上颌受累、术后瘘管和硬件问题是生活质量无法改善的风险。版权所有 © 2024 美国整形外科医生协会。

Osteoradionecrosis (ORN) is an aggressive sequela of head and neck cancer, treatment of which focuses on functional restoration and quality-of-life (QoL). This study aims to identify risks for poor QoL in ORN reconstruction and build a chronologic, longitudinal framework for QoL.A prospective database of reconstructions performed by the senior author was reviewed from 2015-2023. QoL metrics (University of Washington [UWQoL]v4) were prospectively administered prior to surgery, one year post-operatively, and each yearly follow-up.56 ORN patients were included (average 58.2years, mean 6,412Gy radiation). Reconstruction commonly was achieved with the fibula(55.4%) and anterolateral-thigh flaps(37.5%). The total complication rate was 23.2%, median 10.7mo post-operatively.Both "health-related QoL in comparison with prior to cancer diagnosis" (62.5 vs 43.5;p=0.030) and "Overall QoL during the past 7-days" (50.5 vs 41.7;p=0.029) were higher post-ORN reconstruction than before. Physical-QoL was higher pre-cancer reconstruction (79.0) than prior to ORN reconstruction (50.6;p<0.001) and following reconstruction (52.5;p=0.001). Social-emotional function was higher following ORN reconstruction compared to pre-reconstruction (68.7 vs 59.6;p=0.010).On multi-variate analysis, both post-operative social-emotional and physical function were impacted by betelnut use (p=0.038;p=0.025). Poor improvement in QoL from pre to post-ORN reconstruction were affected by maxilla involvement (p=0.048), fistula (p=0.004), and hardware issues (p=0.001).Our longitudinal experience trended decline in QoL at ORN diagnosis with gradual improvement following reconstruction, with eventual social-emotional, pain, anxiety, chewing, and global-QoL significantly improved following surgery. Betelnut was a risk factor for poor post-operative QoL. Maxillary involvement, post-op fistula and hardware issues were risks for non-improvement in QoL.Copyright © 2024 by the American Society of Plastic Surgeons.