腭裂植骨对上颌骨生长发育的影响(动物实验研究)

目的为了寻找拮抗腭裂及腭裂修复术后上颌骨生长抑制的方法，本研究观察了早期延期全裂隙植骨修复动物腭裂模型后，对上颌骨生长发育的影响。方法本研究用４０只狗作实验动物，分成正常对照组和３个实验组，实验组Ｉ外科手术造成右侧完全性腭裂，实验组Ⅱ手术造成右侧完全性腭裂后用两瓣法修补裂隙，实验组Ⅲ手术造成右侧完全性腭裂后用自体肋骨移植并用两瓣法修复裂隙。观察了上颌骨长、宽、高、后面长、宽及鼻中缝与额骨中垂线的夹角变化等指标，并进行统计学分析。结果早期的延期腭裂全裂隙骨移植修复术在拮抗裂隙和裸露骨面对上颌骨横向生长致畸作用的同时，可以诱发新的上颌骨畸形。结论提示临床选用这一修复方法时应采取谨慎的态度     

早期植骨修复腭裂对上颌骨生长影响的实验研究

目的:探讨大白鼠人造腭裂行早期自体骨移植修复对上颌骨生长发育的影响。方法:选取40只4周龄的雄性Wistar大白鼠,随机分为4组,即正常对照组、人造腭裂组、人造腭裂两瓣法修复组、人造腭裂自体骨移植加两瓣法修复组;每组10只。术后10周观察上颌骨的生长发育指标,应用SPSS软件进行统计学处理,再行组间方差分析。结果:上颌骨宽度指标、最大上颌骨长度指标(A-D)、上颌骨高度指标值,植骨修复组均显著小于正常组与人造腭裂组,有统计学意义(P﹤0.01)。两侧硬腭后份宽度指标,植骨修复组显著大于两瓣修复组,有统计学意义(P﹤0.01);其余多项指标,植骨修复组与两瓣修复组均无显著性差异(P﹥0.05),但上颌骨高度的3项指标和长度指标(AD)均值,植骨修复组均小于两瓣修复组。结论:人造腭裂行自体骨移植修复对上颌骨的横向生长有积极意义,但对上颌前后向、垂直向的生长发育较两瓣修复法有进一步受限的倾向。     

牙槽突和硬腭全裂隙植骨修复对腭裂上颌骨模型的生物力学影响

牙槽突及牙槽突加硬腭全裂隙植骨对腭裂上颌骨模型的生物力学影响。方法采用15岁男性患者头颅CT扫描DICOM数据建立3种单侧腭裂上颌骨三维有限元模型,通过叠加不同的植骨块形成牙槽突植骨修复及牙槽突加硬腭全裂隙植骨修复后的腭裂上颌骨模型。在上颌骨前牙区及两侧前磨牙区以正常上唇压力加载负荷,观察各种应力沿上颌骨分布的特点。结果未植骨模型,上颌骨段以变形和移位为主,各种应力集中于上颌骨前壁、牙槽突和腭板等处。植骨模型表现为应力分布均匀化。牙槽突植骨可以显著降低由于上颌骨变形而产生的剪应力和牙槽突的向内移位。牙槽突加硬腭全裂隙植骨可以使得应力分布更加均匀,但是与牙槽突植骨差异不大。结论唇裂修复手术后产生的压力是使未作植骨修复的牙槽突产生变形移位的主要原因。牙槽突植骨修复可以使腭裂上颌骨表面应力分布趋向均匀,生物力学意义重大。牙槽突加硬腭全裂隙植骨可以使得应力分布更加均匀,但与单纯牙槽突植骨效果相比,无显著性差异。     

前颌骨矫正对人工腭裂大鼠上颌骨生长发育影响

目的：探讨前颌骨矫正对上颌骨生长发育的影响;检测上颌骨周围骨缝成骨的活跃程度。方法：以４０ｄＷｉｓｔａｒ大鼠建立人工双侧腭裂模型,Ｌａｔｈａｍ矫正器前颌骨矫正;应用免疫组化和原位杂交技术检测上颌骨周围骨缝ＴＧＦ－β的表达。结果：免疫组化检测,矫正第７,１４天后实验组大鼠ＴＧＦ－β的阳性表达与两对照组之间无显著性差异;原位杂交检测,从第７天开始实验组ＴＧＦ－β ｍＲＮＡ阳性表达明显高于对照组,两对照     

腭裂术后上颌骨生长发育的动物实验研究

有关腭裂的上颌骨生长发育的问题历来是腭裂研究中的焦点之一 ,因为生长发育受多个因素的影响 ,很难将某个因素单独分离出来进行前瞻性研究 ,在临床上研究腭裂术后上颌骨生长发育受到一定限制 ,因此研究常常需要借助于动物实验。一、实验动物的选择各种动物均曾被用于生长发育的研究 ,较常见的是大鼠[1～ 2 ] ,家猫[3 ] ,家兔[4 ] ,犬[5] 以及猪[6] 。尽管一般认为选择种系接近的动物会更有利于研究结果的可靠性 ,但迄今并未见到有文献表明灵长类模型优于其他动物。Ｂａｒｄａｃｈ[7] 等人应用 8周小猎犬和 6周新西兰家兔在同等实验条件下研…     

唇腭裂新生儿前颌骨矫正方法及对上颌骨生长发育的影响

前颌骨矫治是唇腭裂前正畸治疗的第一步,已有４０多年的发展历史,矫治技术趋于成熟,但其对上颌骨生长发育的影响还存在的许多争议,本文对唇腭裂术前矫正的历史,矫正器的分类与基本结构,以及其对上颌骨生长发育的影响作一简要综述。     

双侧腭裂整复术中凿断翼钩与否对上颌骨发育的影响

目的对比在双侧腭裂修复术中凿断翼钩与否,术后患者的上颌骨发育情况.方法选择在3岁以内做双侧腭裂修复手术,术中不凿断翼钩的患者16例,编入试验组.另再选择3岁以内做双侧腭裂修复手术,术中凿断翼钩的患者10例,编入对照组.两组的年龄范围9～12岁,术后追踪9～10年.拍摄每例患者的头颅侧位片,并作头影测量分析,对比两组患者的上颌骨发育情况.结果两组的上颌骨都有明显的矢状向发育不足,下颌骨发育基本正常.测量上颌骨发育的各项目（SNA、A-NP、PP-SN、ANS-FHp、Ptm-A等）的组间差别不明显,说明手术中有无凿断翼钩,对患者的上颌骨发育并无影响.结论在双侧腭裂修复手术中,有无凿断翼钩,对患者的上颌骨发育并无明显影响,但不凿断翼钩有利于保护腭帆张肌,同时也能减少手术创伤,简化手术过程.     

三维CT评价腭裂骨缺损对羊上颌骨发育的影响

目的 采用外科手术方式建立全层、全长腭裂骨缺损的山羊动物模型,并通过头颅CT三维重建来观察和研究单纯腭裂骨缺损对上颌骨生长发育的影响。方法 将8只山羊随机分为2组,组Ⅰ:正常组,4只;组Ⅱ:外科手术方式形成硬腭部0.5 cm×10 cm全层、全长硬腭骨裂隙,4只。于术后32周进行头颅螺旋CT拍摄,然后利用Mimics软件进行颅骨三维重建,对上颌骨长度、宽度和高度进行测量和统计分析。结果 上颌宽度的五个指标中:组Ⅱ均小于组Ⅰ,有统计学差异。上颌长度的一个指标(裂隙侧AH),组Ⅱ小于Ⅰ组,有统计学差异。上颌高度:各组间无统计学差异。结论 硬腭骨缺损阻碍上颌骨宽度和长度的生长发育,提示对腭裂骨缺损进行修复具有积极意义。     

唇裂修复术对上颌骨生长发育影响的初步探讨

目的：进一步了解唇裂修复手术对唇裂伴牙槽突裂和唇腭裂患者上颌骨生长发育影响方面的差异及其机制,方法：将84例唇裂修复术后患者分为唇裂伴牙槽突裂、唇腭裂唇裂修复组和唇腭裂均修复组,并设健康对照组,摄定位头颅线片并测量分析。结果：唇裂修复术对唇腭裂组上凳骨生长发育的影响明显大于唇裂伴牙槽突裂组,结论：唇腭裂的裂与组织缺损是导致唇裂修复影响上颌骨生长的重要原因。     

Effect of alveolar bone grafting on maxillary growth in unilateral cleft lip and palate patients

This cephalometric study reports the extent to which maxillary growth may be impaired by grafting of alveolar bone during the period of mixed dentition. The analysis is confined to subjects with unilateral cleft lip and palate (UCLP). The craniofacial dimensions of a group of 28 children who underwent grafting before the age of 12 years were compared by t-test to those of a nongrafted group (N = 30) at 9 and 16 years of age. In addition, two multiple-regression analyses were performed, the second on a group of 70 subjects with UCLP who received a bone graft between the ages of 8 and 15 years. The principal finding was that bone grafting, even when performed on those as young as 8 or 9 years, had no adverse effect on anteroposterior or vertical maxillary growth. This may be attributable to postponement of grafting until most anteroposterior and transverse growth of the anterior maxilla had ceased and to the grafted tissue's ability to participate in the vertical development of the alveolar process.     

Comparative study on the maxillary symmetry in preoperatively treated children with cleft lip and cleft palate]

Comparative studies on the palatal symmetry in healthy new-born babies and in new-born babies with cheilognathopalatoschisis revealed cleft palates with a high degree of asymmetry. Therefore, it is reasonable to measure the treatment results achieved in cleft patients against the degree of palatal symmetry attained. This evaluation was performed in 30 subjects with unilateral complete cleft and in 20 individuals with bilateral complete cleft.     

完全性唇腭裂婴儿期唇腭裂手术对上颌骨发育的近期影响

目的:观察婴儿早期行唇腭裂手术对完全性唇腭裂患儿上颌骨发育的近期影响.方法: 35 例完全性唇腭裂患儿分为2 组,婴儿期接受唇腭裂手术的20 例为唇腭裂一期修复组,随访时平均年龄(9.99± 0.84) 岁;15 例于婴儿期行唇裂手术未接受腭裂修复的为单纯唇裂修复组,随访时平均年龄(10.24± 1.14) 岁;另20 名无先天性唇腭裂的10 岁龄学童作为正常对照组;3 组分别取头颅侧位片与上牙颌模型,进行测量分析.结果: 2 组唇腭裂患儿之间的上颌骨发育无明显差异,与正常对照组相比较,均有生长抑制.结论:婴儿期行唇腭裂手术的完全性唇腭裂患儿在10 岁左右上颌骨发育与正常儿童存在明显差异,腭裂手术不是引起差异的主要原因,可早期完成该手术.     

Effects of growth on maxillary distraction osteogenesis in cleft lip and palate

PurposeThe objective was to analyze the effects of growth on the long-term result of maxillary distraction osteogenesis (DO) in cleft lip and palate (CLP).Patients and methodsRetrospective study of 24 CLP cases with long-term follow-up operated for maxillary DO using the Polley and Figueroa technique: 10 patients were distracted during growth, while 14 patients were operated after their growth spurt. Preoperative (T0), 6–12 months postoperative (T1), and ≥4 years postoperative (T2) cephalometric radiographs were evaluated. A classical cephalometric analysis was used to assess the treatment stability, and a Procrustes superimposition method was performed to assess local changes in the maxilla and the mandible.ResultsAt T0, the mean age was of 11.9 ± 1.4 years for growing patient, and 17.9 ± 3.5 years for patient treated after their growth spurt (P < 0.001). Between T0 and T1, a greater increase of the SNA was shown in growing patients (P = 0.036), but the relapse was more important between T1 and T2, with a significant decrease of the SNA (P = 0.002) and ANB (P = 0.032) compared to the patients treated after their growth spurt. Although not significant, growing patients showed greater rotations of their palatal plane and mandibular plane.ConclusionsMaxillary DO in CLP does not correct the growth deficit inherent to the pathology. Overcorrection of at least 20% is advised during growth.     

完全性唇腭裂早期腭裂修复对上颌骨发育的影响研究

目的:观察完全性唇腭裂婴儿早期腭裂手术对上颌骨发育的影响.方法:35例完全性唇腭裂患儿分为两组,早期修复组20例,随访时平均年龄9.99±0.84岁.婴儿期未接受腭裂修复者为对照组15例,随访时平均年龄10.24±1.14岁.两组病例分别进行头颅侧位片与上颌牙颌模型测量分析.结果:两组患儿上颌骨及牙弓的测量数据显示差别无显著意义(p＞0.05).结论:完全性唇腭裂患儿早期行腭裂修复术对上颌骨发育不会产生明显影响,可早期进行腭裂手术,有利于患儿正常语音的发育.     

The influence of unilateral cleft lip and palate on maxillary dental arch morphology.

A sample of 97 untreated cleft lip and palate adult patients, with and without Simonart's band, was analyzed. The dimensions and form of the maxillary dental arches were analyzed. Comparison of this sample with a "normal" group indicated maxillary dental arch size and shape are distorted by the presence of a cleft which is characterized by a constriction that becomes more severe in the medial and anterior regions. The presence of Simonart's band affects the cleft arch form, redirecting the anterior extremity of the major segment towards the minor segment.     

腭裂术后硬腭前后部瘢痕对上颌骨生长影响比较的有限元分析

目的 比较腭裂术后硬腭前后部瘢痕对上颌骨生长的抑制情况.方法 利用Ansys软件建立完全性与不完全性腭裂上颌骨三维有限元模型,在2个模型上分别分组施加相同大小、方向但不同受力区域的腭部瘢痕力,第一组在硬腭口腔面前1/4区施加,第二组在硬腭口腔面中前1/4区施加,第三组在硬腭口腔面中后1/4区施加,第四组在硬腭口腔面后1...