Cheung Lim Kwong, Chua Hannah Daile P, Hägg Margareta Bendeus
Hong Kong SAR, China From the Disciplines of Oral and Maxillofacial Surgery and Orthodontics, Faculty of Dentistry, The University of Hong Kong.
Plast Reconstr Surg. 2006 Sep 15;118(4):996-1008. doi: 10.1097/01.prs.0000232358.31321.ea.
This is the first randomized controlled study aiming to compare the postoperative clinical morbidities in cleft lip and palate patients treated with distraction osteogenesis versus conventional orthognathic surgery.
Twenty-nine cleft lip and palate patients with moderate maxillary hypoplasia requiring a maxillary Le Fort I advancement of 4 to 10 mm were randomized into two groups for either internal maxillary distractors or immediate fragment transposition using miniplates and screw fixation. Clinical morbidities were recorded using standardized questionnaires. Skeletal and dental relapses were assessed using lateral cephalometric landmarks.
In the distraction group, two of 15 patients developed infection around the distractors and one patient had an occlusal relapse. Among the 14 patients who received conventional orthognathic surgery, the complications included intraoperative hemorrhage (n = 1), plate exposure leading to sinusitis (n = 1), and occlusal relapse (n = 1). In the skeletal relapses of the osteotomy group, a statistically significant vertical relapse of the A point was noted during the second to twelfth weeks when compared with the distraction group. A statistically significant horizontal relapse of the A and P points during the eighth to twelfth weeks was noted when the osteotomy group was compared with the distraction group.
There were no major differences in the clinical morbidities between the osteotomy and distraction groups. Distraction provided better skeletal stability, whereas there was a significant amount of skeletal relapse in the first 12 weeks after conventional cleft maxillary osteotomy.
这是第一项旨在比较采用牵张成骨术与传统正颌外科手术治疗唇腭裂患者术后临床发病率的随机对照研究。
29例患有中度上颌骨发育不全且需要上颌Le Fort I型前移4至10毫米的唇腭裂患者被随机分为两组，分别接受上颌内置牵张器或使用微型钢板和螺钉固定进行即刻骨块移位。使用标准化问卷记录临床发病率。使用头颅侧位测量标志评估骨骼和牙齿复发情况。
在牵张组中，15例患者中有2例在牵张器周围发生感染，1例患者出现咬合复发。在接受传统正颌外科手术的14例患者中，并发症包括术中出血（n = 1）、钢板暴露导致鼻窦炎（n = 1）和咬合复发（n = 1）。在截骨组的骨骼复发中，与牵张组相比，在第2至12周时观察到A点有统计学意义的垂直复发。当将截骨组与牵张组进行比较时，在第8至12周时观察到A点和P点有统计学意义的水平复发。
截骨组和牵张组在临床发病率方面没有重大差异。牵张提供了更好的骨骼稳定性，而在传统腭裂上颌截骨术后的前12周内有大量的骨骼复发。
