Selim H, Elbargothy N, Nabil Y, El-Hakim I
Oral and Maxillofacial Surgery Department, Dental School, Ain Shams University, Cairo, Egypt.
Dentomaxillofac Radiol. 2009 Jul;38(5):274-80. doi: 10.1259/dmfr/22907015.
Distraction osteogenesis is considered an important reconstruction armamentarium in the management of mandibular deformities and deficiency disorders. The duration of the consolidation period is still a debatable issue among the clinicians. Evaluation of the newly formed bone is the cornerstone for terminating the consolidation period safely. The aim of this study is to find a more conservative protocol for the evaluation of callus distraction by monitoring bone healing using two different examination tools: ultrasonography and dental CT.
Four adult patients (three women and one man) underwent mandibular distraction (using two intraoral and two extraoral devices). The latency period was 5-7 days and the distraction was at a rate of 2 mm per day, with 12-14 weeks of consolidation. All patients were evaluated during activation, 3 months, 6 months and 1 year post-distraction. Evaluation included clinical examination, plain radiographs, CT and ultrasonography examinations.
Ultrasonographic examination of the healing callus revealed four different phases of maturation. These phases were similar to the degree of tissue calcification as measured by CT. Tissue density across the distraction wound at the time of distractor removal (12-14 weeks) was equal to or less than one-third of normal bone density.
Clinical monitoring of mandibular distraction wounds can be successfully achieved through frequent use of ultrasonographic examinations. Standardization of ultrasonography based on CT findings will expand the reliability of ultrasound in monitoring callus maturation. An algorithm for evaluation of distraction wound healing is suggested.
牵张成骨被认为是治疗下颌骨畸形和缺损疾病的重要重建手段。巩固期的时长在临床医生中仍是一个有争议的问题。对新形成骨的评估是安全终止巩固期的基石。本研究的目的是通过使用两种不同的检查工具——超声检查和牙科CT监测骨愈合，找到一种更保守的评估骨痂牵张的方案。
4名成年患者（3名女性和1名男性）接受了下颌骨牵张（使用2个口内装置和2个口外装置）。延迟期为5 - 7天，牵张速率为每天2毫米，巩固期为12 - 14周。所有患者在牵张激活期、牵张后3个月、6个月和1年时接受评估。评估包括临床检查、X线平片、CT和超声检查。
对愈合骨痂的超声检查显示出四个不同的成熟阶段。这些阶段与通过CT测量的组织钙化程度相似。在拆除牵张器时（12 - 14周），牵张伤口处的组织密度等于或小于正常骨密度的三分之一。
通过频繁使用超声检查能够成功实现对下颌骨牵张伤口的临床监测。基于CT结果对超声检查进行标准化将提高超声监测骨痂成熟的可靠性。本文提出了一种评估牵张伤口愈合的算法。
