Havlik R J, Bartlett S P
Division of Plastic Surgery, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia.
J Craniofac Surg. 1994 Nov;5(5):305-10; discussion 311-2. doi: 10.1097/00001665-199411000-00007.
Distraction lengthening is a technique that was initially developed for correction of lower limb length discrepancies. It has recently been adapted to maxillofacial problems and has gained increasing popularity in this application. This report illustrates the principles involved in mandibular distraction lengthening and offers possible solutions to potentially limiting clinical problems. First, conventional technique dictates that a distinct periosteal sleeve is necessary for distraction osteogenesis to occur. However, in this case, distraction was performed through an area of scar tissue in which the native periosteum was destroyed. The ability to extend the use of the technique of distraction successfully to suboptimal clinical situations may broaden the indications for its use. Second, fixator instability is a potentially common problem in these cases because of the forces involved in distraction osteogenesis and the duration of the process. However, mechanical rigidity is essential consolidation (typically requiring twice as long as the distraction phase). Fixator instability can be successfully salvaged during the mineralization phase of bony healing through the use of an onlay corticocancellous bone "plate," which resorbs as the distraction gap gains strength. This report highlights one of the main advantages of the distraction process: the expansion of the soft-tissue matrix of the face.
牵引延长术是一种最初为矫正下肢长度差异而开发的技术。最近它已被应用于颌面问题，并在该应用中越来越受欢迎。本报告阐述了下颌骨牵引延长术所涉及的原理，并针对可能限制临床应用的问题提供了可能的解决方案。首先，传统技术要求有一个完整的骨膜袖套才能发生牵引成骨。然而，在本病例中，牵引是通过一个瘢痕组织区域进行的，该区域的天然骨膜已被破坏。成功地将牵引技术的应用扩展到不太理想的临床情况，可能会扩大其使用指征。其次，由于牵引成骨过程中涉及的力量和该过程的持续时间，固定器不稳定在这些病例中是一个潜在的常见问题。然而，机械刚性对于骨愈合的巩固阶段至关重要（通常需要的时间是牵引阶段的两倍）。在骨愈合的矿化阶段，通过使用一块覆盖性的皮质松质骨“板”，当牵引间隙增强力量时该“板”会吸收，可以成功挽救固定器不稳定的情况。本报告强调了牵引过程的一个主要优点：面部软组织基质的扩张。
