Glat P M, Staffenberg D A, Karp N S, Holliday R A, Steiner G, McCarthy J G
Institute of Reconstructive Plastic Surgery, New York, N.Y.
Plast Reconstr Surg. 1994 Nov;94(6):753-8. doi: 10.1097/00006534-199411000-00001.
The principle of distraction osteogenesis, well-established in the enchondral bones of the axial skeleton, has recently been applied to the membranous bones (mandible, cranium) of the craniofacial skeleton in the experimental animal and in the human. In the craniofacial skeleton, however, the technique has been used only to lengthen bone in a direction along its major axis, i.e., unidimensional distraction. A canine model is presented to demonstrate the feasibility of distracting membranous bone away from its dominant axis, i.e., multidimensional distraction. Four mongrel dogs, 5 months of age, were the subjects of this study. Two osteotomies were made in the zygomatic arch, and the bone-lengthening device was fixed to the zygoma. After 7 days of external fixation, the osteotomized segment was lengthened 1 mm/day away from the long axis of the bone for 15 days. External fixation was then maintained for a minimum of 4 weeks, after which the dogs were sacrificed. Craniofacial CT with three-dimensional reconstruction documented multidimensional bone lengthening, and histologic analysis of the specimen confirmed the presence of new cortical bone in the expanded areas. Refinement in technique and miniaturization and internalization of the bone-lengthening device may allow for more precise changes in the amount and direction of lengthening, thus making distraction osteogenesis more widely applicable for use in the human craniofacial skeleton.
牵张成骨原理在中轴骨骼的软骨内骨中已得到充分确立，最近已应用于实验动物和人类的颅面骨骼的膜性骨（下颌骨、颅骨）。然而，在颅面骨骼中，该技术仅用于沿骨的长轴方向延长骨，即一维牵张。本文介绍了一种犬类模型，以证明牵张膜性骨使其偏离其主导轴的可行性，即多维牵张。本研究以4只5月龄的杂种犬为研究对象。在颧弓上进行了两处截骨，并将骨延长装置固定在颧骨上。在进行7天的外固定后，将截骨段沿骨的长轴方向每天延长1毫米，持续15天。然后至少维持4周的外固定，之后对犬实施安乐死。通过三维重建的颅面CT记录了多维骨延长情况，对标本的组织学分析证实了扩大区域有新的皮质骨存在。技术的改进以及骨延长装置的小型化和内置化可能会使延长的量和方向发生更精确的变化，从而使牵张成骨更广泛地应用于人类颅面骨骼。
