内置式颌骨牵引成骨在疑难牙颌面畸形矫治中的应用——附88例报告

目的：探讨内置式颌骨牵引成骨在各类疑难牙颌面畸形矫治中的应用价值以及不同牵引成骨方式的适应证和优缺点。方法：选择常规口腔颌面外科手术所难以矫治的7类复杂牙颌面畸形88例，采用内置式颌骨牵引成骨矫治，其中包括腭裂继发重度上颌发育不全(9例 )、半侧颜面发育不全(11例)、重度小颌畸形伴阻塞性睡眠呼吸暂停综合征 (17例)、颞下颌关节强直(14例)、颌骨缺失重建(8例)、牙槽突缺失垂直牵引成骨(17例)、上下颌牙弓狭窄牵引成骨扩大(12例)。其中22例采用德国Medico n公司与Martin公司生产的牵引器，其余均采用不同类型的国产牵引器。其截骨方式、牵引器选择与安放、牵引方式依不同患者的畸形分类、畸形严重程度、不同颌骨部位而不同。结果：88例患者年龄最小者4.5岁，最大者54岁，平均22.5岁，上颌骨牵引成骨距离7 ～15 mm，下颌骨12～50 mm。3例因合并局部慢性感染，导致部分新骨吸收；另3例因牵引器故障，下颌下缘骨折等原因另行手术完成牵引；其余所有病例均按术前设计顺利完成牵引成骨，取得了良好成骨效果，并使患者的牙颌面畸形得到满意矫治。结论：内置式颌骨牵引成骨技术为各类复杂疑难牙颌面畸形的矫治提供了新的有效治疗手段，是很有应用价值的新技术，值得推广使用。

The application of internal distraction osteogenesi s of ja ws in correction of difficult and complicated dento-gnatho-facial deformities (report of 88 cases)

Objective: To evaluate the effect of internal distraction osteogenes is in treatment of difficult and complicated dento-gnatho-facial deformities, and to study the advantages, disadvantages, and indications of different distractio n modalities. Methods: Those cases hard to be treated with conve ntional proced ures were selected for study. Seven kinds of dento-gnatho-facial deformities ( 88 cases) were treated with the intraoral distraction osteogenesis technique. They included: 9 cases of severe maxillary hypoplasia secondary to cleft palate, 11 cases of hemifacial microsomia, l7 cases of severe micrognathia accompanie d with obstructive sleep apnea syndrome, l4 cases of TMJ ankylosis, 8 cases of r econstruction of jaw defects, 17 cases of alveolar-bone defect treated by verti c al distraction, and 12 cases with upper and lower dental arch constriction for expansion. The youngest patient was 4.5 years of age, and the oldest 54 year s, with a mean of 22.5 years. The Germany Medicon Co. and Martin Co. produced distr actors were used in 22 cases. In other cases, 7 types of distractors designed an d cooperatively developed by the first author were used. The mode of osteotomy, t he selection and placement of distractor, and the modality of distraction depend ed on the types of deformity, the degree of severity, and the sites of the jaws. Results: The distraction distances in maxilla were 7-l5 mm, and 1 2-50 mm in man dible. 3 cases had local chronic infection leading to resorption of a part of th e new bone; other 3 cases had fracture of the　mandibular inferior border and the troubles of the distractor; they had had addi tional operations to complete the distraction. The other cases went on with dist racti on osteogenesis smoothly obtaining good bone formation, their dento-gnatho-fac ia l deformities were corrected satisfactorily. Conclusion: The intraor al distract ion osteogenesis for jaws provides a new and effective means for those difficult and complicated dento-gnatho- facial deformities which are hard to be treated b y conventional measures. This is a technique of wide application value and worth y to be spread.