State Key Laboratory of Oral Diseases and National Center for Stomatology and National Clinical Research Center for Oral Diseases, Orthognathic and TMJ Surgery Department, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, Sichuan, China.
Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Department of Temporomandibular Joint, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou, China.
Aesthetic Plast Surg. 2024 Aug;48(16):3170-3179. doi: 10.1007/s00266-024-03960-z. Epub 2024 Mar 22.
This in vitro study compared the stability of different fixation method combinations for the zygomatic complex after simulated L-shaped osteotomy reduction malarplasty, a common facial contouring surgery in East Asia with high postoperative complications due to poor fixation methods.
The study used 108 zygoma replicas with various fixation methods combinations in the zygomatic body (L-shaped plate with short wing on zygoma and on the maxilla, two bicortical screws, one bicortical screw with L-shaped plate, square plate, and rectangular plate) and zygomatic arch (Mortise-Tenon structure, 3-hole plate, and Mortise-Tenon structure plus short screw). The failure force under incremental load was applied through the Instron tensile machine to a well-stabilized model using a rubber band simulating the masseter muscle and recorded the increasing force digitally. ANOVA test was used for comparison between recorded values (P < 0.05).
The results showed that the most stable combination was a six-hole rectangular plate and a Mortise-Tenon structure plus one short screw (358.55 ± 51.64 N/mm2). The results also indicated that the placement vector of the fixation methods around the L-shaped osteotomy and the use of the two-bridge fixation method were important factors in enhancing the stability of the zygomatic complex.
The study suggested that surgeons should choose appropriate fixation methods based on these factors to reduce postoperative complications and improve surgical outcomes.
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本体外研究比较了模拟 L 形截骨颧骨降低整形术后不同固定方式组合对颧骨复合体的稳定性，这种手术在东亚地区很常见，但由于固定方式不佳，术后并发症较高。
本研究使用了 108 个带有不同固定方式组合的颧骨模型，包括颧骨体（L 形板带短翼固定于颧骨和上颌骨、双皮质螺钉、L 形板带单皮质螺钉、方形板和矩形板）和颧骨弓（榫卯结构、3 孔板和榫卯结构加短螺钉）。通过 Instron 拉伸机在稳定模型上施加递增负荷的失效力，使用橡胶带模拟咀嚼肌，数字记录增加的力。采用方差分析（ANOVA）检验记录值之间的差异（P<0.05）。
结果显示，最稳定的组合是六孔矩形板和榫卯结构加单短螺钉（358.55±51.64N/mm2）。结果还表明，固定方式在 L 形截骨周围的放置向量和使用双桥固定方式是增强颧骨复合体稳定性的重要因素。
本研究建议外科医生应根据这些因素选择合适的固定方式，以减少术后并发症，提高手术效果。
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