Gosain A K
Department of Plastic and Reconstructive Surgery, Medical College of Wisconsin, Milwaukee 53226, USA.
Plast Reconstr Surg. 2001 Jan;107(1):278-80. doi: 10.1097/00006534-200101000-00050.
In summary, distraction osteogenesis is a safe and effective means of achieving bone lengthening. These techniques were originally applied to the long bones of the extremities; over the past 10 years they have been effectively applied to the bones of the craniofacial skeleton. The new bone regenerate that is observed after distraction osteogenesis is stable, and relapse rates after skeletal advancement are believed to be lower than with conventional osteotomy and bone graft techniques. There is considerable variability in distraction protocols employed in clinical practice, including differences in the types of devices used and in the rate, rhythm, latency, and period of consolidation for distraction osteogenesis. The greatest application for distraction osteogenesis in the craniofacial skeleton has been with mandible lengthening, for which there is presently a 10-year clinical experience. Midfacial advancement is a newer application of distraction osteogenesis, for which clinical experience has been accrued over the past 5 years. This latter experience indicates that distraction osteogenesis is a viable treatment option for lengthening of the hypoplastic mandible and midface. These techniques have advantages over conventional means of bone graft and rigid fixation because of the quality of the bone regenerate, the decrease in the long-term relapse rate of the advanced bone segments in both the mandible and the midface, and the simultaneous soft-tissue elongation that accompanies the distraction process. Distraction osteogenesis is particularly applicable to the correction of severe deformities of the mandible and midface in children with developmental hypoplasia and syndromic craniosynostosis. However, growth is an added variable in this patient population. The amount of overcorrection in lengthening of the hypoplastic bone required to compensate for continued growth discrepancy of the adjacent facial bones is difficult to predict. Therefore, the families of these patients should be informed that many children will require repeated operations at a later age as they reach skeletal maturity.
总之，牵张成骨是实现骨延长的一种安全有效的方法。这些技术最初应用于四肢长骨；在过去10年里，它们已有效地应用于颅面骨骼的骨骼。牵张成骨后观察到的新生骨再生是稳定的，并且骨骼前移后的复发率据信低于传统截骨术和骨移植技术。临床实践中采用的牵张方案存在很大差异，包括所用器械类型以及牵张成骨的速率、节奏、延迟和巩固期的差异。牵张成骨在颅面骨骼中最大的应用是下颌骨延长，目前已有10年的临床经验。面中部前移是牵张成骨的一种较新应用，在过去5年中积累了临床经验。后一种经验表明，牵张成骨是延长发育不全的下颌骨和面中部的一种可行治疗选择。由于骨再生的质量、下颌骨和面中部前移骨段长期复发率的降低以及牵张过程中伴随的软组织同时伸长，这些技术比传统的骨移植和坚固内固定方法具有优势。牵张成骨特别适用于治疗发育不全和综合征性颅缝早闭儿童的严重下颌骨和面中部畸形。然而，生长在这一患者群体中是一个额外的变量。难以预测为补偿相邻面部骨骼持续生长差异而延长发育不全骨骼所需的过度矫正量。因此，应告知这些患者的家属，许多儿童在骨骼成熟时将需要在以后的年龄进行重复手术。
