From the Departments of Oral and Maxillofacial Surgery and Orthodontics and Craniofacial Anomalies, Rambam Health Care Campus; the Ruth & Bruce Rappaport Faculty of Medicine at the Technion-Israel Institute of Technology; and the Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel-Aviv University.
Plast Reconstr Surg. 2018 Dec;142(6):1501-1509. doi: 10.1097/PRS.0000000000004980.
Distraction osteogenesis has widespread clinical use in the treatment of congenital and acquired craniofacial deformities. Nonetheless, during the prolonged consolidation period, the newly regenerated bone carries the risk of complications. A known method for enhancing bone healing is extracorporeal shock wave therapy, which has been shown to induce neovascularization and promote tissue regeneration. The authors investigated whether extracorporeal shock wave therapy can accelerate bony consolidation and regeneration in distraction osteogenesis of the rat mandible and at which stage of distraction osteogenesis it should be applied.
Twenty-four male Sprague-Dawley rats were subjected to distraction osteogenesis of the right mandible (latency period, 3 days; distraction period, 10 days; 0.5 mm/day). Experimental groups consisted of the following: group I (control), no extracorporeal shock wave therapy; group II, extracorporeal shock wave therapy (0.18 mJ/mm(2)) at the latency period; and group III, extracorporeal shock wave therapy (0.18 mJ/mm(2)) at the consolidation period. Explants were removed for evaluation after 4 weeks of consolidation.
Histologic evaluation showed well-developed cortical cortex and a higher degree of bone formation and mature bone in group III; micro-computed tomography showed significantly increased bone mineral density, bone volume fraction, and trabecular thickness; immunohistochemistry demonstrated significantly increased expression of bone morphogenetic protein-2, vascular endothelial growth factor, and proliferating cell nuclear antigen.
Extracorporeal shock wave therapy application at the consolidation period during distraction osteogenesis in the rat mandible enhances bone formation and osteogenic and angiogenic growth factors, improves bone mechanical properties, and accelerates bone mineralization.
牵张成骨术在治疗先天性和后天性颅面畸形方面具有广泛的临床应用。然而，在漫长的愈合期，新再生的骨存在并发症的风险。一种已知的促进骨愈合的方法是体外冲击波治疗，它已被证明能诱导血管生成和促进组织再生。作者研究了体外冲击波治疗是否能加速大鼠下颌骨牵张成骨中的骨愈合和再生，以及它应该在牵张成骨的哪个阶段应用。
24 只雄性 Sprague-Dawley 大鼠进行右侧下颌骨牵张成骨术（潜伏期 3 天，牵张期 10 天，每天 0.5 毫米）。实验组包括以下三组：组 I（对照组），无体外冲击波治疗；组 II，在潜伏期进行体外冲击波治疗（0.18 mJ/mm2）；组 III，在愈合期进行体外冲击波治疗（0.18 mJ/mm2）。愈合 4 周后取出标本进行评估。
组织学评价显示组 III 皮质骨发育良好，骨形成程度和成熟骨更高；微计算机断层扫描显示骨矿物质密度、骨体积分数和小梁厚度显著增加；免疫组织化学显示骨形态发生蛋白-2、血管内皮生长因子和增殖细胞核抗原的表达显著增加。
在大鼠下颌骨牵张成骨的愈合期应用体外冲击波治疗能增强骨形成和成骨及血管生成生长因子，改善骨力学性能，加速骨矿化。
