McCarthy J G, Williams J K, Grayson B H, Crombie J S
Variety Center of Craniofacial Rehabilitation, New York University, Medical Center, New York 10016, USA.
J Craniofac Surg. 1998 Jul;9(4):322-9. doi: 10.1097/00001665-199807000-00006.
Distraction osteogenesis has been shown to be an effective method of lengthening and augmenting endochondral bone. It has also been applied effectively in the reconstruction of the membranous bones of the craniofacial skeleton. With the accumulation of clinical experience in mandibular distraction, the differences between endochondral and membranous bone distraction have become apparent, especially in the limitations of uniplanar distraction for the three-dimensional reconstruction of the deficient mandible. Distraction of the mandible in a single plane cannot satisfy fully the functional and structural requirements of the patient with malocclusion as well as deficiency of the skeletal and soft tissue. This study reports the development and clinical use of a multiplanar mandibular distraction device with the ability to achieve linear distraction (Z-plane or sagittal), angular distraction (Y-plane or vertical), and transverse distraction (X-plane or coronal). The device contains two independent gear arrangements attached to two arms that extend from the central unit. Therefore, the trajectory of the regenerated bone may be changed during the distraction process. The device also allows manipulation of the various planes of movement independent of each other. Furthermore, the rotational points for the multiplanar distraction devices are located at a single point; therefore only a single osteotomy and two pin sites are required. The multiplanar distraction device allows the surgeon to customize and contour the dimensions of the distraction process by controlling the trajectory of the translation of the regenerated bone.
牵张成骨已被证明是延长和增大软骨内骨的有效方法。它也已有效地应用于颅面骨骼膜性骨的重建。随着下颌牵张临床经验的积累，软骨内骨和膜性骨牵张之间的差异变得明显，尤其是在单平面牵张对下颌骨缺损三维重建的局限性方面。在单一平面牵张下颌骨不能完全满足错牙合以及骨骼和软组织缺损患者的功能和结构要求。本研究报告了一种多平面下颌牵张装置的开发和临床应用，该装置能够实现线性牵张（Z平面或矢状面）、角度牵张（Y平面或垂直面）和横向牵张（X平面或冠状面）。该装置包含两个独立的齿轮装置，连接到从中央单元伸出的两个臂上。因此，在牵张过程中再生骨的轨迹可能会改变。该装置还允许彼此独立地操纵各个运动平面。此外，多平面牵张装置的旋转点位于单个点上；因此只需要一次截骨术和两个针孔。多平面牵张装置允许外科医生通过控制再生骨平移的轨迹来定制和塑造牵张过程的尺寸。
