Ueki Koichiro, Moroi Akinori, Yoshizawa Kunio, Hotta Asami, Tsutsui Takamitsu, Fukaya Kenichi, Hiraide Ryota, Takayama Akihiro, Tsunoda Tatsuta, Saito Yuki
Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. K Ueki), Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan.
Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. K Ueki), Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan.
J Craniomaxillofac Surg. 2017 Feb;45(2):178-182. doi: 10.1016/j.jcms.2016.11.007. Epub 2016 Nov 19.
The purpose of this study was to examine skeletal stability and plate breakage after sagittal split ramus osteotomy (SSRO) with the mono-cortical plate fixation, bi-cortical plate fixation, and hybrid fixation techniques using absorbable plates and screws.
A total of 76 Japanese patients diagnosed with mandibular prognathism with and without maxillary deformity were divided into 3 groups randomly. A total of 28 patients underwent SSRO with mono-cortical plate fixation, 23 underwent SSRO with bi-cortical plate fixation, and 25 underwent SSRO with hybrid fixation. Skeletal stability and horizontal condylar angle were analyzed by axial, frontal, and lateral cephalograms from before the operation to 1 year postoperatively. Breakage of the plate and screws was observed by 3-dimensional computed tomography (3DCT) immediately after surgery and after 1 year.
Although there was a significant difference between the mono-cortical plate fixation group and hybrid fixation group regarding right MeAg in T1 (P = 0.0488) and occlusal plane in T1 (P = 0.0346), there were no significant differences between the groups for the other measurements in each time interval. In 2 cases, namely, 6 sides in the mono-cortical plate fixation group, breakage of the absorbable plate was found by 3DCT. However, there was no breakage in the bi-cortical plate fixation group and hybrid fixation group.
This study results suggested that there were no significant differences in the postoperative skeletal stability among the 3 groups, and bi-cortical fixation as well as hybrid fixation was a reliable and useful method to prevent plate breakage even if an absorbable material was used.
本研究旨在探讨使用可吸收接骨板和螺钉的单皮质接骨板固定、双皮质接骨板固定及混合固定技术在矢状劈开下颌支截骨术（SSRO）后骨骼的稳定性及接骨板断裂情况。
总共76例诊断为下颌前突伴或不伴上颌畸形的日本患者被随机分为3组。28例患者接受单皮质接骨板固定的SSRO，23例接受双皮质接骨板固定的SSRO，25例接受混合固定的SSRO。通过术前至术后1年的轴向、正位和侧位头颅X线片分析骨骼稳定性和髁突水平角。术后即刻及术后1年通过三维计算机断层扫描（3DCT）观察接骨板和螺钉的断裂情况。
虽然单皮质接骨板固定组和混合固定组在T1期的右侧MeAg（P = 0.0488）和T1期的咬合平面（P = 0.0346）存在显著差异，但各时间间隔内其他测量指标在组间无显著差异。在2例患者中，即单皮质接骨板固定组的6侧，通过3DCT发现可吸收接骨板断裂。然而，双皮质接骨板固定组和混合固定组未出现断裂情况。
本研究结果表明，3组术后骨骼稳定性无显著差异，即使使用可吸收材料，双皮质固定和混合固定也是预防接骨板断裂的可靠且有用的方法。
