Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kanazawa University, 13-1 Takaramachi, Kanazawa 920-8641, Japan.
J Craniomaxillofac Surg. 2011 Jun;39(4):237-43. doi: 10.1016/j.jcms.2010.06.008. Epub 2010 Aug 11.
The purpose of this study was to examine bone healing after Le Fort I osteotomy in Class III patients.
The study group consisted of 18 Japanese patients with mandibular prognathism with and without asymmetry, maxillary retrognathism or open bite. A total of 36 sides were examined. Le Fort I osteotomy was performed without a pterygoid osteotome, with an ultrasonic curette used to remove interference at the pterygomaxillary region. Titanium plates (Universal Mid-face fixation module, Stryker, Freiburg, German) were used for four patients, absorbable plates (poly-L-lactic acid (PLLA): NEOFIX(®), Gunze, kyoto, Japan) were used for four patients and other absorbable plates (uncalcined and unsintered hydroxyapatite and poly-L-lactic acid (uHA/PLLA): super FIXSORB(®)MX, Takiron Co. Ltd, Osaka, Japan) were used for 10 patients, in the same manner. Postoperative computed tomography (CT) was analyzed for all patients pre-operatively and 1 year postoperative. The anterior and lateral areas between the maxillary segments were measured with 3-dimensional (3D) CT. Bone healing at the pterygomaxillary region was also assessed.
There were no significant differences in the area of bone defect healing among the plate types. The areas of bone defect after 1 year were significantly smaller than that immediately after surgery on the right side (p=0.0145) and left side (p=0.0010) in the frontal view and right side in the lateral view (p=0.0118). Bone healing at the pterygomaxillary junction was found in all cases without artificial pterygoid plate fracture. Fourteen of 22 sides with artificial pterygoid plate fracture by an ultrasonic curette showed bone continuity between the pterygoid plate and posterior part of maxilla.
This study suggested that bony healing could occur in spaces between the segments of maxilla and pterygomaxillary regions as well as the region of the anterior and lateral walls in the maxilla, but it is not always complete within 1 year after Le Fort I osteotomy.
本研究旨在探讨 Le Fort I 截骨术后 III 类错颌患者的骨愈合情况。
研究组包括 18 例下颌前突伴或不伴不对称、上颌后缩或开颌的日本患者。共检查 36 侧。行 Le Fort I 截骨术时未使用翼突骨凿，采用超声骨刀去除翼突-上颌区域的干扰。4 例患者使用通用面中部固定模块钛板（Stryker，Freiburg，德国），4 例患者使用可吸收板（聚 L-乳酸（PLLA）：NEOFIX(®)，Gunze，京都，日本），10 例患者使用其他可吸收板（未煅烧和未烧结的羟基磷灰石和聚 L-乳酸（uHA/PLLA）：super FIXSORB(®)MX，Takiron Co. Ltd，大阪，日本），以相同的方式。所有患者均在术前和术后 1 年进行术后计算机断层扫描（CT）分析。使用 3D CT 测量上颌骨段之间的前外侧区域。还评估了翼突-上颌区域的骨愈合情况。
不同类型的钢板在骨缺损愈合面积上无显著差异。与术前相比，术后 1 年右侧（p=0.0145）和左侧（p=0.0010）额视图以及右侧侧视图（p=0.0118）的骨缺损面积明显减小。在所有病例中，均未发现翼突骨板骨折的人工翼突板骨折。22 个经超声骨刀导致人工翼突板骨折的侧中，14 个显示翼突板和上颌后段之间存在骨连续性。
本研究表明，Le Fort I 截骨术后，上颌骨段之间、翼突-上颌区域以及上颌前外侧壁区域都可能发生骨愈合，但在截骨术后 1 年内并不总是完全愈合。
