经缝牵引成骨术治疗唇腭裂生长发育期患者的面中部发育不全：临床结果及骨骼变化分析。

Trans-Sutural Distraction Osteogenesis for Midfacial Hypoplasia in Growing Patients with Cleft Lip and Palate: Clinical Outcomes and Analysis of Skeletal Changes.

机构信息

Beijing, Jinan, and Xiamen, People's Republic of China From the Department of Cleft Lip and Palate, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; the Department of Stomatology, Beijing Children's Hospital, Affiliated to Capital University of Medical Sciences; the Department of Aesthetic, Plastic and Burn Surgery, Shandong Provincial Hospital Affiliated to Shandong University; and the Department of Burns and Plastic Surgery, First Affiliated Hospital of Xiamen University.

出版信息

Plast Reconstr Surg. 2015 Jul;136(1):144-155. doi: 10.1097/PRS.0000000000001375.

DOI:10.1097/PRS.0000000000001375

PMID:26111320

Abstract

BACKGROUND

Although maxillary distraction osteogenesis has been used for early treatment of midfacial hypoplasia, the inevitable osteotomies are still a complicated and invasive procedure for growing patients. Based on the bone-borne trans-sutural distraction osteogenesis, novel improvements to the approach were made to treat midfacial hypoplasia, and the clinical outcomes and skeletal changes were analyzed.

METHODS

Seventy consecutive growing cleft lip and palate patients with midfacial hypoplasia were treated with trans-sutural distraction osteogenesis. The distraction system consists of a rigid external distractor, nickel-titanium shape memory alloy spring, and bone-borne traction hooks. The whole distraction process was recorded in detail clinically. Lateral cephalographs and computed tomographic scans were taken and analyzed by cephalometric measurement and color-map analysis to assess the skeletal changes.

RESULTS

All of the patients except one achieved satisfactory appearance and occlusal relationship. The unilateral maximum traction force presented an increased trend with age, but this relationship was not absolute. The whole trans-sutural distraction osteogenesis process was divided into three clinical stages: the startup period, the rapid movement period, and the consolidation period. Cephalometric analysis showed a great increase in SNA, ANB and horizontal movement of the maxillae after distraction, but with marginal relapse at 6 to 18 months postoperatively. Visualized changes of the midfacial skeleton were observed by three-dimensional color mapping. The results showed an unequal advancement in different regions.

CONCLUSION

Trans-sutural distraction osteogenesis process with adaptations offers an alternative method for the early treatment of midfacial hypoplasia in growing patients with cleft lip and palate.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

摘要

背景

尽管上颌骨牵引成骨术已被用于早期治疗面中部发育不全，但对于生长中的患者来说，不可避免的骨切开术仍然是一种复杂且具侵袭性的手术。基于骨内经缝牵引成骨术，我们对该方法进行了一些改进，用于治疗面中部发育不全，并分析了其临床结果和骨骼变化。

方法

70 例连续的伴有面中部发育不全的单侧完全性唇腭裂生长患者接受了经缝牵引成骨术治疗。该牵引系统由刚性外部牵引器、镍钛形状记忆合金弹簧和骨内牵引钩组成。整个牵引过程均详细记录在案。拍摄侧位头颅侧位片和 CT 扫描，并通过头影测量和彩色图谱分析进行分析，以评估骨骼变化。

结果

除 1 例外，所有患者均获得了满意的外观和咬合关系。单侧最大牵引力随年龄呈增加趋势，但这种关系并非绝对。整个经缝牵引成骨术过程分为三个临床阶段：启动期、快速移动期和巩固期。头影测量分析显示，牵引后 SNA、ANB 和上颌骨水平移动均有显著增加，但术后 6 至 18 个月有轻微复发。通过三维彩色图谱观察到面中部骨骼的可视化变化。结果显示不同区域的推进程度不均等。