猴下颌升支矢状有劈开前徙术后骨愈合区的X线和光镜研究

通过对猴下颌升支矢状骨劈开前徙术后３、６、１２和２４周时骨段连接区的Ｘ线和光镜组织学研究发现，术后的骨愈合过程以次级愈合为主。术后第６周可获得相对稳定的骨连接。在达到充分减张的前提下，尽可能保留升支内外侧肌附丽，有利于提供充足血供和促进骨愈合。下颌以太劈开前徙术有充足的骨创界面，是矫治颌骨畸形的一种理想手术     

下颌升支矢状劈开截骨术后退和前徙下颌骨对下颌运动范围的影响

作者对接受下颌升支矢状劈开截骨术患者（下颌骨后退１１例，下颌骨前徙１０例）手术前自下颌运动范围进行了测量，并对颞下颌关节进行了临床检查。发现在术后６个月时，后退组患者的张口度已恢复到术前水平，前徙组患者的张口度仍低于术前，且差异有高度显著性（Ｐ＜０．０１），术后两组患者下颌前伸和侧向运动（左右）均无明显变化。提示下颌升支矢状劈开截骨术后退下颌骨对患者张口度影响较小，且术后恢复较快。     

下颌升支矢状劈开截骨术后下颌骨短期稳定性的三维分析

目的:本研究利用三维测量方法分析下颌骨在下颌升支矢状劈开截骨术后短期内的复发趋势.方法:收集在北京大学口腔医院接受正颌-正畸联合治疗并行下颌升支矢状截骨手术的患者共49例,分为下颌前徙患者22例,下颌后退患者27例,收集术前4 d(T0)、术后4 d(T1)、术后4～6周(T2)、3个月(T3)的CBCT数据,利用计算机辅助设计软件Pro Plan进行三维头颅重建,建立坐标系并测量下颌骨相关指标.利用SPSS 20.0软件对T1、T2时的测量结果进行配对t检验.结果:在接受下颌升支矢状劈开截骨术的患者中,下颌前徙患者的下颌骨在B点、Pg点存在水平向的复发趋势,下颌平面存在顺时针旋转的倾向.下颌后退患者的下颌骨在B点存在水平向的复发趋势,Pg点存在水平向和垂直向的复发趋势.结论:下颌升支矢状劈开截骨术后术后下颌骨在短期内存在复发倾向,但在临床可接受范围内.     

双侧升支矢状劈开截骨后退下颌术后骨的稳定性的研究

目的：探讨双侧升支矢状劈开截骨术（BSSRO）后退下颌骨以钢丝结扎固定两骨段加颌间固定术后骨的稳定性，了解导致复发的有关因素。方法：双侧下颌升支矢状劈开截骨手术后退下颌的患者14例，于手术前1周，手术后1周，术后6个月分别拍摄定位头颅侧位片及许勒位X线片，用于测量下颌移动的距离及确定下颌骨髁状突的位置。结果：双侧下颌升支矢状劈开截骨后退术后，6个月的复发率为27.2%，多元逐步回归分析示下颌后退的距离与复发相关。结论：BSSRO后退下颌骨的距离越大，术后下颌骨向前移位的可能越大。     

下颌升支矢状劈开截骨术后颞下颌关节形态和功能变化

下颌升支矢状劈开截骨术 (ＢＳＳＲＯ)对颞下颌关节(ＴＭＪ)形态和功能的影响是很多学者研究的问题 ,且对下颌升支矢状劈开截骨术后颞下颌关节是否发生形态改变和关节功能紊乱存在争议[1] 。本文通过 16例下颌升支矢状劈开截骨术的病例对颞下颌关节是否发生形态改变和关节功能紊乱进行了随访研究。1　材料与方法1.1　一般临床资料1996年 1月～ 2 0 0 1年 12月共 130例正颌外科手术。从中选出 16例下颌双侧升支施行矢状劈开截骨术 (ＢＳＳＲＯ)的病例进行随访研究 ,其中女 7例 ,男 9例 ,平均年龄 2 3.5 (18～ 2 6 )岁。下颌前突 11例 ,上颌后…     

常见正颌手术后咬合关系的维护和调整

目的 探讨临床常见的正颌手术后,如何很好的维护和调整上下牙列的咬合关系,为临床提供有益的参考.方法 选择骨性Ⅰ类双颌前突行根尖下截骨后徙术、Ⅱ类下颌后缩行下颌升支矢状劈开前徙术、Ⅲ类骨性反骀行下颌升支骨切开后退及合并上颌前徙术各6例患者,共18例患者.正颌手术后依据分类分别行3种不同的牵引模式进行咬合调整.结果 18例...     

下颌升支矢状劈开截骨术矫治下颌前突体会

下颌升支矢状劈开截骨术矫治下颌前突体会山东莱钢医院口腔科吴洪敏，陶书振１９８９年以来我科采用下颌升支矢状劈开截骨术（Ｓａｇｉｔｔａｌｓｐｌｉｔｒａｍｕｓｏｓｔｅｏｔｏｍｙ，ＳＳＲＯ）矫治下颌前突畸形１０例，取得良好效果，现总结如下。临床资料本组１０例...     

经口内下颌支矢状截骨矫正下颌前突(附14例报告)

经口内下颌支矢状劈开截骨术,Obwegecer1975年首先提出,Pont(1960)对该术式进行了改进,以后国内外学者均有不少改进。我们采用经口内下颌支矢状劈开截骨的方法,使下颌升支内外骨板截骨等手     

双侧下颌升支矢状劈开后退术后骨稳定性评价

目的 探讨影响双侧下颌升支矢状劈开后退术并行坚固内固定后骨稳定性的因素。方法 对进行双侧矢状劈开后退术后的15例患者于术后1周及术后1年摄头影测量侧位片,对其相关角度及线距进行测量,并作统计学处理。结果 下颌矢状劈开后退术1年后的平均复发量为2.5mm,后退量>6mm组与后退量<6mm组两者变化量之间无显著性差异。结论 下颌双侧矢状劈开后退术并行坚固内固定是矫正下颌前突最有效的方法之一。     

双侧下颌升支矢状截骨下颌前徙术的手术配合

总结一例双侧下颌升支矢状截骨下颌前徙术病例的手术配合。术前根据患者的心理状况采取了针对性的心理护理,作好术前准备和术中配合工作,手术经过顺利,术后恢复情况良好。     

Modified sagittal split ramus osteotomy with a reciprocating saw and new retractors

Modified sagittal split ramus osteotomy with new instruments and a reciprocating saw is reported. With this modification, the sagittal separation of the ramus is performed by the reciprocating saw with an original wide-blade buccal retractor and a new lingual retractor, instead of the traditional channeled retractor. The wide-blade retractor is inserted to the buccal aspect of the mandibular ramus, which ensures protection from instrumental injury to the adjacent soft tissues and vessels, and the new lingual retractor, instead of the channeled retractor, is inserted to the lingual aspect of the ramus. The osteotomy line follows that of Dal Pont's modification. Close attention must be paid to the direction of the saw blade. The separated bone plane should be located in the external cortical bone layer of the ramus, so as to avoid injury of the inferior alveolar neurovascular bundle. The osteotomy is completed with the smooth osteotomized interface, which facilitates positioning of the bone segments by the surgeon. The new instruments and the reciprocating saw may provide safe and rapid sagittal split ramus osteotomy.     

Osseous healing of the sagittal ramus osteotomy: a histologic comparison of rigid and nonrigid fixation in Macaca mulatta.

Twenty-three adult female rhesus monkeys underwent advancement of the mandible by the sagittal split ramus osteotomy. Twelve had the proximal and distal segments wired together and underwent 6 weeks of maxillomandibular fixation (MMF). Eleven animals had bicortical bone screws placed between the segments and no postsurgical MMF. The animals were killed at 6 and 12 weeks and the osteotomy sites were prepared for histologic examination. Overall, the results showed that the two groups of animals underwent markedly different patterns of osseous healing. The osteotomy sites in the MMF animals were filled with callus, which then formed bone. In contrast, no callus was found in the majority of the rigid fixation osteotomy sites; direct bony deposition was found instead. The results of this investigation show that, like long bones, the sagittal osteotomy can heal by direct or indirect means depending on the rigidity of the fixation.     

Bone healing after Le Fort I osteotomy with SSRO,using uHA/PLLA plates and screws,in class II and III patients

PurposeThe purpose of this study was to compare bone healing after Le Fort I osteotomy with sagittal split ramus osteotomy (SSRO) in class II and class III patients.Patients and methodsThe subjects consisted of 46 Japanese class II and III patients. Le Fort I osteotomy was performed in combination with SSRO. They were divided into two groups (23 class II cases and 23 class III cases). Four absorbable plates (uncalcined and unsintered hydroxyapatite and poly-l-lactic acid — uHA/PLLA) and screws were used to fix the maxillary segment in all patients, in the same manner. Postoperative computed tomography (CT) was analyzed for all patients at 1 week and 1 year postoperatively. The anterior and lateral areas between the maxillary segments were measured using two-dimensional frontal and lateral views from the three-dimensional images reconstructed over a constant CT value.ResultsThere were no significant differences in the area of bone defect healing between classes II and III at 1 year postoperatively, although there were significant differences between the two groups at 1 week postoperatively (p < 0.05). Furthermore, there were no significant differences in the areas of bone defect between 1 week and 1 year postoperatively, in both groups.ConclusionUsing measurements based on CT value threshold within 1 year after Le Fort I osteotomy, this study suggests that the areas of bony defect in the region of the anterior and lateral walls of the maxilla do not always decrease in both classes II and III.     

Comparison of osseous healing after sagittal split ramus osteotomy and intraoral vertical ramus osteotomy

The sagittal split ramus osteotomy (SSRO) is generally associated with greater postoperative stability than the intraoral vertical ramus osteotomy (IVRO); however, it entails a risk of inferior alveolar nerve damage. In contrast, IVRO has the disadvantages of slow postoperative osseous healing and projection of the antegonial notch, but inferior alveolar nerve damage is believed to be less likely. The purposes of this study were to compare the osseous healing processes associated with SSRO and IVRO and to investigate changes in mandibular width after IVRO in 29 patients undergoing mandibular setback. On computed tomography images, osseous healing was similar in patients undergoing SSRO and IVRO at 1 year after surgery. Projection of the antegonial notch occurred after IVRO, but returned to the preoperative state within 1 year. The results of the study indicate that IVRO is equivalent to SSRO with regard to both bone healing and morphological recovery of the mandible.     

Osseous healing after a sagittal splitting ramus osteotomy

The purpose of this study was to examine osseous healing in the cleavage between the bone fragments after sagittal splitting ramus osteotomy (SSRO) utilizing computed tomography (CT). The subjects were 13 patients with mandibular prognathism who underwent bilateral SSRO. CT was used to study the rami immediately after surgery, then 6 months, 1 year, and 2 years after surgery. Many concave type (the angle between the cleavage >90°) anterior borders developed into the stairway type (the angle between the cleavage <90°) 6-12 months after surgery. Few borders changed to the smooth type. Almost all of the stairway and concave posterior borders changed to the smooth type in the 6-12 months after surgery. Regarding the posterior borders 1 year after surgery, the cleavage of distal and proximal bone fragments demonstrated stable osseous healing (smooth type) in cases where the length and width between the bone fragments were large. In conclusion, the authors successfully demonstrated detailed osseous healing in the cleavage between the bone fragments after SSRO. Remodelling between bone fragments is a major mechanism of osseous healing after this procedure.     

3D打印技术在双侧下颌升支矢状劈开截骨术中的应用

目的 探讨3D打印技术制作的截骨导板在双侧下颌升支矢状劈开截骨术（BSSO）中的应用效果。方法 选择32例（男17例,女15例,年龄19~35岁,平均23.5岁）下颌发育不良的患者为研究对象,进行BSSO（Hunsuck模式,64侧）,所有患者术前均进行锥形束CT（CBCT）扫描并建立下颌骨3D模型,使用3D打印技术制作下颌骨升支内侧水平骨切口截骨导板。64侧手术分别由年轻主治医师或具有丰富正颌手术经验的专家（主任医师）使用或不使用截骨导板来完成,对各组完成下颌升支内侧水平骨切口的时间进行计时。术后复查CBCT并按照LSS（lingual split scale）分类来评估手术效果。结果 术后所有患者口内切口均一期愈合,无严重并发症。各组完成下颌升支内侧水平骨切口时间的差异有统计学意义（F=30.059,P<0.05）,其中主治医师不使用导板组的手术用时明显高于其他3组（P<0.05）,其余各组两两比较无明显差异（P>0.05）。尽管所有64侧手术均按照标准方式进行,仅有59.38%（38/64）的骨折线遵循标准Hunsuck骨劈开线,21.88%（14/64）骨折线累及下颌神经管,其余18.75%（12/64）是其他方式。经列联表分析和Fisher确切概率法检验发现,截骨导板的使用影响舌侧骨劈开线的方式（P<0.05）。结论 3D打印技术制作的截骨导板能够帮助年轻医师更快更好地完成BSSO。     

Rapid lengthening of rabbit mandibular ramus by using nitinol spring: a preliminary study

Nitinol is well known for its shape memory and superelasticity, which means it can return to its original shape from large deflections and produce moderate forces in the process. Based on these characteristics, the authors attempted to use an internal Nitinol spring for automatic lengthening of mandibular ramus. Twenty adult white rabbits underwent transverse osteotomy in unilateral mandibular ramus to remove a 15.0 mm condylar segment and L-osteotomy in remnant ramus to create a vascularized transport disc. The S-shaped Nitinol spring, with two ends bent as perpendicular underprops, was constricted and secured across the transverse gap of L osteotomy by the underprops. Six animals were killed 6 days after operation for observation of bone transport rate. Other surviving rabbits were killed 8 weeks later for morphologic and histologic examination. Mechanical testing revealed moderate output of tensile elasticity by constricted spring on shape recovery in 37 degrees C. Rapid lengthening of mandibular ramus, more than 9.0 mm in 5 to 6 days, and new bone formation in 8 weeks were found. The radiograph and histologic appearance of regenerated bone was similar to those seen with traditional distraction osteogenesis. This preliminary study demonstrates the possibility of spring-mediated rapid mandibular lengthening across an osteotomy. However, the method needs additional scientific investigation for its clinical feasibility.     

腭裂伴发牙颌畸形正颌治疗的述评

本文报告２０例腭裂伴牙颌畸形的正颌治疗。手术方法：上颌作ＬｅＦｏｒｔＩ型截骨术，下颌作矢状劈裂截骨术，上颌作牙槽骨段截骨术和上，下颌联合作牙槽骨段截骨术。临床效果：与腭裂修复术同期施行ＬｅＦｏｒｔＩ型截骨术者，容貌与功能均获得改善，在腭裂修复术后，分期作ＬｅＦｏｒｔ型截骨术者，术后６周即出现复发现象。下颌行矢状劈裂截骨术皆能获得预期效果，单颌或双颌作牙槽骨段截骨术者，无论是同期还是分期手术，都属效果满意病例。本文着重对手术指征，手术术式，术后复发、同期手术进行述评，并主张该手术能改善容貌与咀嚼功能即是确当的方法，不必要求以美貌人的标准来苛求划一。     

下颌升支倒L形截骨术结合髂骨移植术矫治成年下颌发育不足畸形

目的 评价应用下颌升支倒L形截骨术结合髂骨移植术矫治成年下颌发育不足畸形的效果.方法 2010年1月—2016年5月11例下颌发育不足患者接受了口内或口外入路的下颌升支倒L形截骨术和髂骨移植术.结果 通过下颌升支倒L形截骨术和髂骨移植术使得所有患者的下颌升支高度和宽度得到有效扩展,面型及咬合明显改善,术后未见严重并发症.结论 下颌升支倒L形截骨术结合髂骨移植术矫治成年下颌发育不足畸形是安全、有效的,是临床上值得考虑和选择的矫治成年下颌发育不足畸形的合理术式.     

Inferior alveolar nerve function after sagittal split osteotomy of the mandible: correlation with degree of intraoperative nerve encounter and other variables in 496 operations

A total of 1034 patients who had undergone orthognathic surgery were examined after 2 years; 818 had been treated with varying types of mandibular osteotomy such as vertical ramus osteotomy, sagittal split ramus osteotomy, and genioplasty. Neurosensory function in the mental nerve region was assessed by evaluating light touch perception.The incidence of neurosensory deficiency was 216/548 (39%) after sagittal split ramus osteotomy, 26/140 (19%) after extraoral vertical ramus osteotomy, 9/78 (12%) after genioplasty and 60/650 (9%) after intraoral vertical ramus osteotomy. Additional genioplasty increased both the incidence and severity of neurosensory disturbance after intraoral vertical ramus osteotomy but did not significantly influence the neurosensory function after sagittal split ramus osteotomy.The incidences of neurosensory disturbance after mandibular osteotomies in this report correspond well with those previously reported, but the incidence of almost 40% after sagittal split ramus osteotomy must be considered a disquieting drawback of the procedure.