Habal M B
Tampa Bay Craniofacial Center, Florida, USA.
Clin Plast Surg. 1996 Jan;23(1):93-101.
Bone repair by regeneration as we know it continues to undergo changes, with advances approaching that may change our treatment of patients with craniofacial deformities and skeletal defects. Perhaps by the turn of the century, patients born with asymmetric deformities due to lack of growth will be treated early in life by skeletal stretching, and then later in life by skeletal distraction that is followed by use of accelerating factors to assist the healing processes. All of these available modalities are part of the regeneration of new bone formation. The future of such changes is very interesting, and our ability to help our patients will be maximized. We may even look back 25 years from now at bone grafting and find it to be obsolete and crude. It is hoped that with the new modalities being developed, we will not deviate from the use of a bone grafting procedure, which is the workhorse of the craniofacial surgeon. Bone grafting is used by all surgeons working on the craniofacial skeleton despite the problems of unpredictability of healing and an inability to calculate what percentage of the original graft will survive. The transplantation issue will be solved. The problems with donor site morbidity will continue. The use of inorganic bone substitutes will continue to have its limitation, particularly in type II wounds, which we as plastic surgeons see in the craniofacial region. As we redefine our approach to skeletal repair, we may look back and find solutions to some of the major problems we have had. The rapid stretch of soft tissue after facial advancement or structural alteration that is accompanied by a relapse due to the elastic recoil of the soft tissue could be eliminated by gradual distraction. The bone will undergo better functional adaptation when it has a gradual change in structure based on adjustment and molding in a gradual fashion. The problem of donor site morbidity and a prediction formula for bone could be resolved with new bone formation in situ by mineralization of the area under repair. Bone healing enhancers are here to stay and their clinical application will produce a far-reaching better final outcome (Fig. 11).
我们所知的通过再生进行骨修复仍在不断变化，随着技术进步的临近，可能会改变我们对面部畸形和骨骼缺损患者的治疗方式。也许到本世纪末，因生长不足而出生时患有不对称畸形的患者，在幼年时将通过骨骼拉伸进行治疗，随后在成年后通过骨骼牵张治疗，之后使用促进愈合的因子来辅助愈合过程。所有这些可用的方式都是新骨形成再生的一部分。这种变化的未来非常有趣，我们帮助患者的能力将得到最大化。从现在起25年后，我们甚至可能回顾骨移植并发现它已过时且粗糙。希望随着新方式的发展，我们不会偏离骨移植手术的使用，因为它是颅面外科医生的主要手段。尽管存在愈合不可预测以及无法计算原始移植物存活百分比的问题，但所有从事颅面骨骼手术的外科医生都会使用骨移植。移植问题将会得到解决。供区发病的问题仍将存在。无机骨替代物的使用仍将有其局限性，尤其是在我们整形外科医生在颅面区域所见的II型伤口中。当我们重新定义骨骼修复的方法时，我们可能会回顾并找到解决我们曾遇到的一些主要问题的方法。面部推进或结构改变后软组织的快速拉伸，以及由于软组织弹性回缩而导致的复发，可以通过逐渐牵张来消除。当骨骼基于逐渐的调整和塑形而结构逐渐变化时，它将经历更好的功能适应。通过修复区域的矿化原位形成新骨，可以解决供区发病问题以及骨的预测公式。骨愈合增强剂将会持续存在，它们的临床应用将产生更深远的更好的最终结果（图11）。
