Roth D A, Gosain A K, McCarthy J G, Stracher M A, Lefton D R, Grayson B H
Institute of Reconstructive Plastic Surgery, New York University School of Medicine, New York, USA.
Plast Reconstr Surg. 1997 Apr;99(5):1237-47; discussion 1248-50. doi: 10.1097/00006534-199704001-00005.
Distraction osteogenesis has become an accepted method of treatment for patients requiring reconstruction of hypoplastic mandibles. We present a quantitative analysis of volumetric changes after distraction osteogenesis in a series of 10 patients. Group I (n = 5 patients, 3 unilateral craniofacial microsomia, 1 Goldenhaar syndrome, and 1 bilateral craniofacial microsomia) underwent unilateral distraction of the mandible. Group II (n = 5 patients, 1 Nager syndrome, 1 bilateral craniofacial microsomia, 1 developmental micrognathia, and 2 Treacher Collins syndrome) underwent bilateral distraction of the mandible. Predistraction and postdistraction axial and three-dimensional computed tomographic (CT) scans were digitized and transferred to a computer for analysis with image-processing software to determine the changes in volume of the mandible and bony regenerate. The CT-derived volume method was validated by scanning three dry cadaver mandible specimens and comparing the volume data with those derived from a water-displacement method. The difference between the two methods was less than 5 percent. The mean distracted length, as recorded from the calibrated device, was 22.6 mm in the 10 patients. In the unilateral distraction group, the mean increase in hemimandibular bone volume was 2.8 cc, with a mean percentage increase of 27 percent in the distracted hemimandible. In the bilaterally distracted patients, the mean increase in total mandibular volume was 7.9 cc, with a mean percentage increase in bone volume of 25 percent. This study represents the first attempt to quantify the increase in bone volume resulting from distraction osteogenesis. Quantitative volumetric analysis of CT scans is an accurate method to measure the amount of bone regenerate in patients undergoing distraction osteogenesis of the mandible or the extremities. The concept and utility of quantifying the volumetric changes in bone following distraction osteogenesis may become more important as multiplanar devices are developed and used in other areas of the craniofacial skeleton.
牵引成骨术已成为治疗需要重建发育不全下颌骨患者的一种公认方法。我们对10例患者牵引成骨术后的体积变化进行了定量分析。第一组（n = 5例患者，3例单侧颅面短小畸形、1例Goldenhaar综合征和1例双侧颅面短小畸形）接受下颌骨单侧牵引。第二组（n = 5例患者，1例Nager综合征、1例双侧颅面短小畸形、1例发育性小下颌畸形和2例Treacher Collins综合征）接受下颌骨双侧牵引。牵引前和牵引后的轴向及三维计算机断层扫描（CT）被数字化并传输到计算机，使用图像处理软件进行分析，以确定下颌骨和骨再生的体积变化。通过扫描三个干燥尸体下颌骨标本并将体积数据与水置换法得出的数据进行比较，验证了CT衍生体积法。两种方法之间的差异小于5%。根据校准装置记录，10例患者的平均牵引长度为22.6毫米。在单侧牵引组中，半侧下颌骨体积平均增加2.8立方厘米，牵引侧半侧下颌骨平均百分比增加27%。在双侧牵引的患者中，下颌骨总体积平均增加7.9立方厘米，骨体积平均百分比增加25%。本研究首次尝试量化牵引成骨术导致的骨体积增加。CT扫描的定量体积分析是测量下颌骨或四肢牵引成骨术患者骨再生量的准确方法。随着多平面装置在颅面骨骼其他区域的开发和应用，量化牵引成骨术后骨体积变化的概念和实用性可能会变得更加重要。
