Bradley James P, Gabbay Joubin S, Taub Peter J, Heller Justin B, O'Hara Catherine M, Benhaim Prosper, Kawamoto Henry K
Los Angeles, Calif.; and New York, N.Y. From the Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, and Division of Craniofacial and Pediatric Plastic Surgery, Westchester Medical Center.
Plast Reconstr Surg. 2006 Dec;118(7):1585-1597. doi: 10.1097/01.prs.0000233010.15984.4d.
Treatment of midface hypoplasia and forehead retrusion with monobloc advancement is associated with significant complications, including meningitis, prolonged intubation, and frontal bone flap necrosis. To see whether distraction of the monobloc segment offered decreased morbidity, the authors compared clinical outcomes of patients who underwent conventional monobloc advancement with those of patients who underwent monobloc distraction.
Group 1 (conventional monobloc; n = 12) underwent traditional monobloc advancement with bone grafting. Group 2 (modified monobloc; n = 11) did not receive ventriculoperitoneal shunts and underwent the above procedures with placement of a pericranial flap and fibrin glue over the midline defect. Group 3 (monobloc distraction; n = 24) underwent advancement of the monobloc segment by distraction osteogenesis using internal distraction devices. Complications included meningitis, cerebrospinal fluid leak, frontal bone flap loss, and wound infection. Preoperative, postoperative, and follow-up lateral cephalograms were used to assess horizontal changes of the forehead, midface, and maxilla.
Group 3 (distraction monobloc) had the lowest complication rate (8 percent), followed by groups 2 (modified monobloc; 43 percent) and 1 (conventional monobloc; 61 percent) (p < 0.05). Group 3 achieved greater advancement (12.6 mm) than did group 2 (9.4 mm) or group 1 (9.1 mm) (p < 0.05). Relapse was least in group 3 (8 percent) compared with groups 2 (67 percent) and 1 (45 percent).
Monobloc advancement by distraction osteogenesis had less morbidity and achieved greater advancement with less relapse compared with conventional methods of acute monobloc advancement with bone grafting. Monobloc distraction is superior to conventional methods of acute monobloc advancement and is an alternative to staged fronto-orbital advancement followed by Le Fort III advancement.
采用整块前移术治疗面中部发育不全和额部后缩会引发包括脑膜炎、长时间插管以及额骨瓣坏死等严重并发症。为探究整块骨段牵张是否能降低发病率，作者对比了接受传统整块前移术患者与接受整块骨段牵张术患者的临床结果。
第1组（传统整块骨段组；n = 12）接受传统整块前移术并植骨。第2组（改良整块骨段组；n = 11）未接受脑室腹腔分流术，采用上述手术方法，并在中线缺损处放置帽状腱膜瓣和纤维蛋白胶。第3组（整块骨段牵张组；n = 24）使用内部牵张装置通过牵张成骨术使整块骨段前移。并发症包括脑膜炎、脑脊液漏、额骨瓣缺失和伤口感染。术前、术后及随访的头颅侧位X线片用于评估额部、面中部和上颌骨的水平变化。
第3组（牵张整块骨段组）并发症发生率最低（8%），其次是第2组（改良整块骨段组；43%）和第1组（传统整块骨段组；61%）（p < 0.05）。第3组前移程度（12.6 mm）大于第2组（9.4 mm）或第1组（9.1 mm）（p < 0.05）。与第2组（67%）和第1组（45%）相比，第3组复发率最低（8%）。
与传统的急性整块骨段前移植骨术相比，牵张成骨整块前移术发病率更低，前移程度更大且复发率更低。整块骨段牵张术优于传统的急性整块骨段前移术，是分期额眶前移术联合勒福III型前移术的一种替代方法。
