Tavakoli K, Stewart K J, Poole M D
St. George Hospital, Kogarah, Sydney, Australia.
Ann Plast Surg. 1998 Jan;40(1):88-99. doi: 10.1097/00000637-199801000-00020.
Distraction osteogenesis is a technique of new bone formation by the gradual separation of bony fragments. The method, although initially developed for limb lengthening, is now being applied in the treatment of craniofacial deformities. A number of principles have been established through careful scientific study to guide clinical practice, such as the ideal rate and rhythm of distraction, the need for periosteal preservation during bone division, a "latent period" of neutral fixation before, and a "consolidation period" after distraction. The technique is being applied in craniofacial surgery particularly for mandibular deformities and offers considerable advantages over previous methods such as osteotomy and inlay bone grafting. Donor site morbidity is avoided, the investing soft tissue envelope is concurrently expanded, and the magnitude of the procedure is less. However, the technique is still in its infancy and requires further modification and refinement before widespread acceptance as a treatment in mainstream craniofacial surgery. Problems with cutaneous scarring and socially undesirable external hardware, particularly in the pediatric population, have led to the emergence of intraoral miniature devices, with the ultimate goal of development of a multiplanar internal autodistractor. Furthermore, many principles well established in leg lengthening, such as the rate and rhythm of distraction, need to be reexamined and the parameters redefined with particular reference to the craniofacial skeleton. Distraction osteogenesis has an expanding role in craniofacial surgery.
牵引成骨术是一种通过逐渐分离骨碎片来形成新骨的技术。该方法最初是为肢体延长而开发的，现在正应用于颅面畸形的治疗。通过仔细的科学研究已经确立了一些原则来指导临床实践，例如理想的牵引速率和节奏、骨切开时保留骨膜的必要性、牵引前的中立固定“潜伏期”以及牵引后的“巩固期”。该技术在颅面外科手术中尤其适用于下颌骨畸形，与诸如截骨术和嵌体骨移植等先前方法相比具有相当大的优势。避免了供区并发症，同时扩张了覆盖的软组织包膜，手术范围也较小。然而，该技术仍处于起步阶段，在被广泛接受为主流颅面外科手术的一种治疗方法之前，还需要进一步的改进和完善。皮肤瘢痕形成和外观不佳的外部固定装置问题，特别是在儿童患者中，导致了口内微型装置的出现，其最终目标是开发一种多平面内部自动牵引器。此外，许多在腿部延长中确立的原则，如牵引速率和节奏，需要重新审视，并根据颅面骨骼重新定义参数。牵引成骨术在颅面外科手术中的作用正在不断扩大。
