Boutault F, Diallo O-R, Jalbert F, Lopez R, Lauwers F
Service de chirurgie maxillofaciale et chirurgie plastique de la face, CHU de Toulouse-Purpan, place Baylac, 31059 Toulouse cedex, France.
Rev Stomatol Chir Maxillofac. 2010 Feb;111(1):7-10. doi: 10.1016/j.stomax.2009.07.003.
The use of miniplates in orthognatic surgery, and especially for Le Fort I osteotomies, has brought great improvement in technical aspects, postoperative evolution, and long-term stability. Nevertheless, accurate modelling of theses plates remains problematic because the right balance between malleability and rigidity is hard to determine. This is why we designed an original new miniplate model. The aim of this study was to assess our new model in clinical settings.
This novel plate was made of two lateral sockets with two holes on each side, linked by a central bar, 1mm thick like the plate. Three lengths were available. A mechanical study proved that this plate was stronger than a 0.6 millimeter thick plate and that its adaptability was much superior to that of a common 1-mm thick plate. We retrospectively studied 180 patients having undergone a Le Fort I osteotomy with or without mandibular osteotomy. Follow-up ranged from 6 to 12 months. Congenital abnormalities were excluded.
Bone healing was achieved without any complication in due time for all but two patients. In one case, a plate fracture was observed. In the other case, a slight mobility of the upper jaw appeared after removal of the device. No intolerance was observed.
This novel miniplate seems to be improved when compared to other available devices. Rigid osteosynthesis of a Le Fort I osteotomy can be problematic because of the repositioning gap and the variable anatomy of the maxilla. The device must be rigid enough, inconspicuous, and well tolerated. Only three plate lengths are necessary to treat all cases, which reduces cost and storage. The only requirement is to mandatorily insert four plates every time. Removal of the plates does not seem necessary.
微型钢板在正颌外科手术中的应用，尤其是用于勒福Ⅰ型截骨术，在技术层面、术后恢复及长期稳定性方面都带来了极大的改善。然而，这些钢板的精确塑形仍然存在问题，因为难以确定柔韧性和刚性之间的恰当平衡。这就是我们设计一种全新原创微型钢板模型的原因。本研究的目的是在临床环境中评估我们的新模型。
这种新型钢板由两个侧面的套接部件组成，每侧有两个孔，通过一根与钢板厚度相同、为1毫米的中央杆连接。有三种长度可供选择。一项力学研究证明，这种钢板比0.6毫米厚的钢板更坚固，其适应性也远优于普通的1毫米厚钢板。我们回顾性研究了180例行勒福Ⅰ型截骨术的患者，其中部分患者还同时行下颌骨截骨术。随访时间为6至12个月。排除先天性异常患者。
除两名患者外，所有患者均按时实现骨愈合且无任何并发症。其中一例观察到钢板骨折。另一例在取出固定装置后出现上颌轻微活动。未观察到不耐受情况。
与其他现有装置相比，这种新型微型钢板似乎有所改进。由于复位间隙和上颌解剖结构的变异性，勒福Ⅰ型截骨术的坚固内固定可能存在问题。该装置必须足够坚固、不显眼且耐受性良好。只需三种钢板长度就足以治疗所有病例，这降低了成本并减少了储存需求。唯一的要求是每次必须植入四块钢板。似乎没有必要取出钢板。
