运用输送盘牵张成骨术重建猴下颌髁突的实验研究

目的研究在猴颞下颌关节（TMJ）缺损动物模型上运用输送盘牵张成骨术重建髁突的可行性及其整复效果。方法选取6只成年恒河猴,手术截除其双侧关节髁突与关节盘,在下颌升支部行“L”形骨切开术,形成骨输送盘,并安置自行研制的牵张器。按每次0.4 mm,每次间隔12 h的牵张速率向上牵引输送盘至关节窝。牵张结束后第4、12、24周各处死2只动物。通过影像学分析和组织学检查评价输送盘改建与牵张间隙内新骨生成情况。以术中切除的髁突作为正常对照组。结果术后所有动物都有不同程度的咬合错乱,牵张结束后咬合基本恢复正常。骨输送盘形态基本接近正常髁突,其下方可见大量软骨细胞;牵张间隙内新骨生成良好。结论输送盘牵张成骨术可以重建一个形态和功能都基本接近正常的髁突,这种技术可以作为一种整复TMJ缺损的新方法。     

牵张成骨重建下颌骨节段性缺损术后数字化种植修复的3年回顾性病例系列研究

目的:探究牵张成骨重建下颌节段性缺损术后进行数字化种植修复的疗效.方法:本研究采用回顾性病例系列分析,共纳入2016年10月—2021年8月间由四川大学华西口腔医院种植科收治的4例(共8个种植位点)应用输送盘牵张成骨术(transport disc distraction osteogenesis,TDDO)进行颌骨重...     

输送盘牵张成骨重建下颌髁突的骨密度和力学性能变化

目的 探讨运用输送盘牵张成骨术重建髁突的骨密度和力学性能变化.方法 成年山羊16只.截除右侧髁突后运用输送盘牵张成骨术重建髁突,左侧作为正常对照组.牵张结束后24周处死所有动物.采用双能X线吸收法和压缩力学性能测试技术.定量分析并对比两侧髁突的骨密度和压缩力学性能变化.结果 手术侧髁突骨密度较正常侧显著升高;其轴向弹性模量和最大应力较正常侧显著升高,横向弹性模量和最大应力两侧无显著性差异,轴向和横向最大应变两侧均无显著性差异.髁突骨松质的力学性能具有明显的各向异性.结论 运用输送盘牵张成骨术重建的髁突的骨密度和生物力学性能明显升高;这种适应性改建与颞下颌关节的功能刺激直接相关.     

输送盘牵张成骨术重建下颌髁突后对下颌骨生长发育的影响

目的:研究输送盘牵张成骨术重建下颌髁突后对下颌骨生长发育的影响.方法:选用3～4 月龄健康幼年雄性山羊16 只,手术切除右侧髁突(保留关节盘),在右下颌升支行反"L"形骨切开术形成骨输送盘,并安置牵张器.以每日2 次,每次0.4 mm的速率向上牵引输送盘至关节窝.在手术后当天、牵张结束后当天、牵张结束后4、12、24、48 周时行三维CT检查评价输送盘改建及牵张间隙内新骨形成情况,并分别于12、24、48 周3 个时间点各处死动物2 只对新生髁突做组织学检查.牵张结束后48 周时处死剩余10 只动物,对下颌骨及重建髁突形态进行观察与测量.左侧下颌骨作为正常对照组.结果:三维CT显示新生髁突形态逐渐改建并接近正常髁突,牵张间隙新骨生成良好.大体观察发现新生髁突体积较正常侧明显增大,但下颌骨的生长与正常侧无显著差异.新生髁突表面有一层纤维软骨覆盖,组织学结构与正常关节软骨类似.结论:输送盘牵张成骨重建髁突未对下颌骨的生长发育产生明显影响;下颌运动产生的功能刺激是下颌骨继续生长发育的主要原因.     

MSCs移植促进输送盘骨牵张术修复颅骨缺损的实验研究

目的 :研究自体骨髓间充质干细胞 (MSCs)对采用输送盘骨牵张术修复山羊颅骨缺损效果的影响。方法 :将成年雄性山羊 8只 ,随机分为A、B两组 ,每组 4只。在动物颅顶区制造全层颅骨缺损和输送盘 ,用自行研制的牵张器行输送盘骨牵张术修复颅骨缺损。牵张结束后 ,在A组动物牵张区注入体外培养的自体骨髓间充质干细胞 ;B组同期注入生理盐水作对照。在牵张结束后的第 4周处死A、B两组动物 ,取牵张区新生组织标本行组织学和扫描电镜分析。结果 :移植MSCs的A组动物牵张区新骨生成速度和钙化程度显著高于B组动物。结论 :局部移植MSCs可能有促进牵张成骨的作用。     

用三焦点牵张成骨技术修复重建颏部骨缺损的实验研究

目的:探讨应用三焦点牵张成骨技术修复重建颏部骨缺损的可行性及其方法。方法:选取4只成年恒河猴,通过下颌前份骨截除术形成颏部正中联合骨缺损。在两侧下颌体部各制备一个输送盘,并用自行研制的可调式多平面牵张装置使双侧输送盘向前内方向缓慢移动,并在颏部正中对接以修复重建颏部骨缺损。通过X线片与螺旋CT三维重建技术检查双侧输送盘移动与新骨形成情况。在牵张结束的第8和16周分别处死2只动物,取下颌骨牵张区标本作组织学检查。结果:牵张结束后,4只恒河猴的颏部形态接近正常猴,X线片与螺旋三维CT片显示两侧输送盘远心端在正中成功对接。牵张结束的第8周,螺旋三维CT与实验组织学观察发现牵张间隙内均有新骨形成;两侧输送盘在下颌正中呈纤维连接,并可见活跃的成骨和改建活动。牵张结束的第16周,牵张间隙内新骨成熟,两侧输送盘下颌正中逐渐呈纤维骨性连接。结论:用可调式多平面牵张装置进行三焦点牵张成骨可以作为修复重建颏部骨缺损的一种选择手段。     

上颌骨大型缺损时颧骨牵张成骨重建骨性支持2例报告

近年来,在颌骨缺损修复领域,牵张成骨技术由于具备无需植骨,手术操作简单,创伤和风险小,成骨期抗感染能力强,成骨质量好,软、硬组织同期修复等优点,成为研究热点,应用范围不断拓展.但颧骨牵张成骨的研究和应用为数甚少,且多为外置式牵张成骨矫正颧骨畸形［1,2］.作者首次实现颧骨牵张成骨在上颌骨低位重建骨性支持,为进一步修复奠定良好基础.     

内置自加载牵张器重建兔下颌支的实验研究

目的 :探索牵张成骨重建下颌支缺损的新方法。方法 :以成年新西兰兔为实验动物 ,手术切除下颌骨一侧部分升支及髁状突 ,造成 1.5cm的节段性骨缺损 ,骨断端”L”形截骨形成传送盘 ,安置可完全埋置于组织内的镍钛记忆合金牵张器 ,术后 2个月时处死实验动物 ,取下颌骨观察骨缺损修复情况。结果 :镍钛记忆合金牵张器能自动完成牵张成骨 ,初步重建了缺损的下颌支 ,组织学检查可见牵张区有良好的新骨再生。结论 :内置镍钛记忆合金牵张器可自动持续弹性加载牵张成骨 ,可望成为一种具有良好应用前景的简便实用技术。     

牵张成骨在下颌骨缺损修复中的应用和进展

牵张成骨是源于矫形外科的一种全新的治疗理念,近年来被引入颌面部缺损的重建。本文就牵张成骨在重建下颌骨节段性缺损的优越性及其在各种类型下颌骨缺损中的应用进行综述,并对牵张成骨在下颌骨缺损中应用的进一步研究方向进行了展望。     

牵张成骨在下颌骨缺损修复中的应用和进展

牵张成骨是源于矫形外科的一种全新的治疗理念，近年来被引入颌面部缺损的重建。本文就牵张成骨在重建下颌骨节段性缺损的优越性及其在各种类型下颌骨缺损中的应用进行综述，并对牵张成骨在下颌骨缺损中应用的进一步研究方向进行了展望。     

Long-term effects of rigid fixation on the growing craniomaxillofacial skeleton.

Fixation of craniomaxillofacial bones with plates and screws is becoming an increasingly popular method of managing patients with maxillofacial fractures, congenital anomalies, and skeletal defects after tumor extirpation. The effects of rigid fixation on growth, however, are not well defined and remain controversial. This experimental work was designed to evaluate the effects of rigid fixation on the growing craniomaxillofacial skeleton. Eight 2-month-old beagle dogs were divided into two groups. Cephalometric analysis and computed tomography were obtained preoperatively to establish a baseline of the craniomaxillofacial skeleton. Rigid fixation using plates and screws was applied across the intact coronal and nasofrontal sutures. The contralateral side served as the control. The periosteum was elevated over the contralateral suture and replaced without any surgical intervention. The animals were killed one year after application of rigid fixation, when they had achieved full and mature skeletal growth. The skulls were evaluated both grossly and cephalometrically. There was bony growth over some of the plates, as well as sclerosis of the plated suture lines. Cephalometric analysis demonstrated consistent asymmetry between the plated and nonplated sides, with deviation of the midline toward the plated side in all of the animals. Although further studies are necessary to clarify this issue fully, we conclude from our study that rigid fixation during skeletal development can potentially alter the growth patterns of the craniomaxillofacial skeleton and should be used with caution.     

Analysis of calvarial bone defects in rats using microcomputed tomography: potential for a novel composite material and a new quantitative measurement

Reconstruction of craniomaxillofacial defects is a challenge for surgeons and has psychological and functional burdens for patients. Undoubtedly, there is a need for improved biomaterials and techniques for craniomaxillofacial reconstruction.     

个体化模板在单侧颧眶颌复合体骨折复位中的临床应用

目的探讨应用个体化模板提供外科设计及术中精确导向定位的临床意义。 方法选择单侧颧眶颌骨折患者25例,通过术前三维CT扫描,对颅颌骨进行重建。采用计算机辅助设计（CAD）及相应快速成形技术（RP）在健侧的颅面中部骨结构CT数据上制作患侧面中部骨表面的多块（3 ~ 4块）个体化模板,利用模板作为术中导向,精确复位颧眶颌复合体（ZOMC）骨折。 结果所有患者中,由健侧面中部骨结构CT数据重建的患侧虚拟面中部骨结构继之形成的表面外形模板,均能很好的应用于骨折复位中,各标志点术后水平非对称率均小于3%,单侧ZOMC骨折均获得对称性的复位。 结论应用CAD和RP联合设计,制作多块个体化模板,通过导向定位精确复位ZOMC骨折,是ZOMC骨折复位重建的新的成功应用。     

脂肪间充质干细胞在颅颌面修复重建中的应用

颅颌面软硬组织缺损是临床常见病和多发病,对患者容貌和功能均有严重妨碍。其修复重建是涉及多学科的综合性临床难题,目前仍有不少问题亟待解决。组织工程的发展为颅颌面修复重建带来了新的思路,而种子细胞来源是组织工程研究的首要问题。近年来,脂肪间充质干细胞因其具有来源广泛、取材方便、诱导条件下多向分化、扩增能力强等优点而成为较为理想的种子细胞。本文就脂肪间充质干细胞在颅颌面修复重建中的应用进展作一综述。     

延长垂直下斜方肌岛状肌皮瓣修复重建大型头颈部缺损

颈横动脉供血的延长垂直下斜方肌岛状肌皮瓣(extended vertical lower trapezius island myocutaneous flap,eVLTIMF)用于修复重建大型头颈部缺损安全可靠。该瓣制备较简单,成活率高。供区较隐蔽,可直接关闭缝合,并发症少,肩部运动受影响较小;还可制备成折叠瓣,合并其他带蒂瓣或合并肩胛骨骨肌皮瓣修复特大洞穿性缺损或下颌骨缺损。eVLTIMF在头颈部大面积缺损修复,尤其是在晚期复发性头颈部肿瘤挽救手术后巨大缺损修复重建中起着重要作用。本文对斜方肌的临床应用解剖、 eVLTIMF瓣制备及其在颅颌面、口腔颌面和颌颈区缺损修复中的应用作一阐述。     

The temporoparietal galea flap

The temporoparietal galea flap has been rediscovered as a useful tissue transfer technique. It is the only single-layered fascial flap that can be transposed into the craniofacial and head and neck region on its vascular pedicle. In the 1990s, it was used extensively in the surgical reconstruction of a wide variety of defects in the craniomaxillofacial area, ranging from scalp and auricle defects to nasal and maxillo-orbital repair to all types of intraoral and even mandibular and pharyngeal reconstructions.     

Virtual planning for craniomaxillofacial surgery – 7 Years of experience

Contemporary computer-assisted surgery systems more and more allow for virtual simulation of even complex surgical procedures with increasingly realistic predictions. Preoperative workflows are established and different commercially software solutions are available. Potential and feasibility of virtual craniomaxillofacial surgery as an additional planning tool was assessed retrospectively by comparing predictions and surgical results. Since 2006 virtual simulation has been performed in selected patient cases affected by complex craniomaxillofacial disorders (n = 8) in addition to standard surgical planning based on patient specific 3d-models. Virtual planning could be performed for all levels of the craniomaxillofacial framework within a reasonable preoperative workflow. Simulation of even complex skeletal displacements corresponded well with the real surgical result and soft tissue simulation proved to be helpful. In combination with classic 3d-models showing the underlying skeletal pathology virtual simulation improved planning and transfer of craniomaxillofacial corrections. Additional work and expenses may be justified by increased possibilities of visualisation, information, instruction and documentation in selected craniomaxillofacial procedures.     

Reconstruction of large performated maxillofacial defect with immediated revascularized flap]

Patients with large perforated maxillofacial defects resulting from combined craniomaxillofacial resection or extended extra cranio-maxillofacial resection due to malignances in this region had been reconstructed with large revascularized myocutaneous flap or combined pedicled myocutaneous flap with revascularized flap.Since January,1981,a total of 29 flaps was used,of which 28 flaps survived successfuly,whereas one free forearm flap being failed to survive due to venous embolization was replaced with pedicled forehead flap.The results in postoperative appearance and rehabilitation of physiological function were relatively satisfactory.Finally,selection of flap and method of reconstruction were introduced and experiences on immediate reconstruction after malignance resection reported.     

不同类型胸大肌皮瓣修复颅颌面缺损

目的研究不同类型胸大肌皮瓣修复不同部位和类型颅颌面缺损的临床效果。方法传统的带蒂胸大肌皮瓣修复颊、面下部、舌、口底等部位缺损354例;带蒂双叶胸大肌皮瓣修复面颊部洞穿性缺损7例;带蒂肋骨胸大肌皮瓣修复舌、口底、下颌骨复合性缺损2例;带蒂胸大肌筋膜瓣修复舌、口底缺损15例;游离胸大肌皮瓣修复颅底、上颌骨、颧面部缺损4例,胸肩峰动静脉分别与颌外动脉、颈外静脉或面总静脉吻合。结果带蒂胸大肌皮瓣完全成活338例,3例完全坏死,4例部份坏死。带蒂双叶胸大肌皮瓣6例完全成活,1例完全坏死。带蒂肋骨胸大肌皮瓣及游离胸大肌皮瓣全部成活。带蒂胸大肌筋膜瓣完全成活,肌瓣表面在术后3~4个月出现黏膜化,但其中2例肌瓣表面在术后3个月时仍有大量肉芽组织增生,彻底清创后方黏膜化。结论不同部位、不同类型的组织缺损应选用不同种类的胸大肌皮瓣修复,其操作简便、成功率高,扩大了适应证。     

3D打印辅助颌面骨缺损与畸形的临床精准修复重建

目的:探讨3D打印技术在颌面骨缺损与畸形的修复重建手术中的应用价值.方法:治疗颌面骨缺损与畸形手术病例6例.术前行三维CT扫描、重建并3D打印1∶1实物模型.根据模型进行疾病诊断、手术设计及植入物的预制.结果:3D打印的头模全方位显示了骨缺损及病变区域的状况,实现了生物修复板的术前、体外精确预制;实证了头影测量分析的结果,实现了真正意义上的模型外科;利用镜像模型进行重建板精确弯制,恢复了患者面型及下颌骨高度.结论:3D打印能全方位、直观、精确地显示颌面骨的三维空间关系,对于颌面骨缺损与畸形的修复重建手术有极大的临床指导价值.