经缝牵引成骨早期矫正儿童面中份发育不全

目的 临床探索经缝牵引、均衡前移面中份骨骼，早期矫治面中份发育不全的新技术新方法。方法 选择6～12岁面中份发育不全的患儿，采用弹性外牵引装置矫正面中份发育不全。牵引系统由经鼻孔插入的骨承力牵引装置、面弓和牙科正畸用的橡皮圈组成。全麻下于梨状孔外下缘的外侧钻孔，通于下鼻道的前部；或在硬腭的前部钻孔，穿透鼻底。经鼻孔将骨牵引承力装置插入梨状孔缘或鼻底的骨孔内。手术后第1～2天用连接于面弓和骨牵引装置的正畸橡皮圈进行牵引。牵引力为600～1200g，随骨骼移动的进度不断调整。骨骼移动达到预定的位置后，减小牵引力维持牵引。结果 临床治疗9例患儿。面中份骨骼移动均衡。患者面容和咬合关系完全恢复正常。面部侧面观显示上、中、下各部分协调匀称，眶下、颧部和上唇部丰满，鼻背挺拔。结论中位缝牵引技术能够早期有效地矫正面中份畸形，骨骼前移均衡，且方法简便，损伤小。

Trans-sutural distraction osteogenesis for early correction of midfacial hypoplasia in children: a primary clinical report

OBJECTIVE: To probe the possibility of trans-sutural distraction osteogenesis for correction of children midfacial hypoplasia. METHODS: The trans-sutural distraction system of mid-facial skeleton consisted of the bone-borne traction hooks of titanium, the face-bow, and the elastic loops. Nine children with midfacial hypoplasia were treated at their 6 - 12 years of age. No osteotomy was made in them. Bone holes were drilled with a dental bur at each side of the lateral-inferior rim of the aperture, or at the anterior part of the hard palate. The traction device was hitched to the holes through the nostrils. Protraction began 3 days postoperatively, with the forces adjusted dependently upon the rate of progress. When the skeleton reached to the planed position, it was retained with a minor force for 8 weeks. RESULTS: The mid-facial skeleton of the nine children showed a balanced advancement. Their facial profile and cross-bite were corrected satisfactory. CONCLUSIONS: Patients with severe mid-facial hypoplasia could be corrected ideally by the new technique, with minor trauma, easy manipulation. The design of protraction system was reasonable.