Peacock Zachary S, Salcines Alfonso, Troulis Maria J, Kaban Leonard B
Assistant Professor, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA.
DMD Candidate, Harvard School of Dental Medicine, Boston, MA.
J Oral Maxillofac Surg. 2018 Jul;76(7):1512-1523. doi: 10.1016/j.joms.2017.12.034. Epub 2018 Jan 31.
This was a retrospective cohort study of children who underwent mandibular DO during the primary or mixed dentition period and before completion of somatic growth (boys aged ≤14 years and girls aged ≤12 years) at Massachusetts General Hospital from 1996 to 2014. From the DO registry, patients were selected who had complete clinical and radiographic records and at least 1 year of follow-up. Patients with disorders of dental development (eg, ectodermal dysplasia) were excluded. Panoramic radiographs were used to assess changes in morphology, eruption, and orientation of the dentition. Standardized digital lateral cephalograms were used to assess the mandible (sella-nasion-B point, mandibular unit length, ramus height, body length) preoperatively, at the end of distraction, at 1 year after device removal, and at longest follow-up.
A total of 118 patients of all ages in the registry underwent some form of DO during the study period. For assessment of the effects on dentition, 26 subjects, who had 36 osteotomies and distraction wounds, met the inclusion criteria. In this sample, 22 of 26 subjects (85%) had 52 adverse effects in 38 of 90 permanent teeth (42.2%) assessed. Cephalometric measurements indicated that there was net mandibular growth at longest follow-up, after a period of skeletal relapse from the end of distraction to 1 year after device removal; however, only 2 of 25 subjects (8%) regained a growth rate in the vector of DO that matched or exceeded normal age- and gender-matched controls.
DO commonly results in adverse effects on the dentition within and adjacent to the DO gap, with only a minority resolving over time. Net growth of the mandible occurs after DO but at a slower rate and lesser magnitude than that of age- and gender-matched controls.
1）评估接受下颌骨牵张成骨术（DO）的儿科患者再生区域及其附近恒牙的转归，2）比较牵张下颌骨与年龄和性别匹配的对照组术后的生长情况。
这是一项回顾性队列研究，研究对象为1996年至2014年在马萨诸塞州总医院接受下颌骨DO治疗的儿童，治疗时间为乳牙期或混合牙列期且在身体生长完成之前（男孩年龄≤14岁，女孩年龄≤12岁）。从DO登记册中选取具有完整临床和影像学记录且至少随访1年的患者。排除患有牙齿发育障碍（如外胚层发育不良）的患者。使用全景X线片评估牙列的形态、萌出和方向变化。术前、牵张结束时、拆除装置后1年以及最长随访时，使用标准化数字侧位头影测量片评估下颌骨（蝶鞍-鼻根点-B点、下颌单位长度、升支高度、体部长度）。
登记册中共有118名各年龄段患者在研究期间接受了某种形式的DO。为评估对牙列的影响，26名有36处截骨术和牵张创口的受试者符合纳入标准。在该样本中，26名受试者中的22名（85%）在评估的90颗恒牙中的38颗（42.2%）出现了52处不良反应。头影测量结果表明，在从牵张结束到拆除装置后1年出现骨骼复位的一段时间后，最长随访时下颌骨有净生长；然而，25名受试者中只有2名（8%）在DO方向上恢复的生长速率与年龄和性别匹配的正常对照组相当或超过该对照组。
DO通常会对DO间隙内及其附近的牙列产生不良反应，只有少数随着时间推移而缓解。DO后下颌骨会出现净生长，但生长速率比年龄和性别匹配的对照组慢，生长幅度也较小。
