颧骨弧线式牵张成骨修复部分上颌骨缺损的初步实验

目的探讨用颧骨弧线式牵张成骨修复部分上颌骨缺损的可行性。方法2只犬为实验动物，用内置弧线式骨牵张器颧骨牵张成骨，模拟修复上颌骨缺损，固定8周后取材，行大体标本观察，光镜及扫描电镜观察。结果骨移动盘显著改变方向、内旋，弧线式牵引约12mm，整体结构呈弧形，固定8周时，新生骨骨质密度接近正常，与双侧正常骨质连续。结论颧骨弧线式牵张成骨修复部分上颌骨缺损具有临床应用的可能性。     

颧骨牵张成骨部分修复上颌骨缺损

目的：探讨应用颧骨弧形牵张成骨修复部分上颌骨缺损的临床应用可能性。方法：为1例行右上颌骨全切术,左上颌骨次全切除术患者,以自行研制的内置弧形骨牵张器行颧骨内置弧形牵张成骨术。术后延迟1w行骨牵引,共牵引3w,固定期螺旋CT观察新骨生成状况。结果：治疗内容均按计划完成。螺旋CT显示,牵引结束时,骨移动盘实现显著的改向、内旋,弧线式牵引右侧约20mm,左侧约15mm;固定期8个月时,新生骨骨质密度接近正常,与双侧正常骨质连续,弧线完整平滑,颧骨弧形牵张成骨完成,骨性支持结构于上颌骨低位建立。结论：颧骨内置弧形牵张成骨术可有效修复部分上颌骨缺损,在上颌骨低位重建骨组织支持,为进一步修复奠定良好基础,可望实现功能性重建。     

颧骨牵张成骨修复上颌骨部分缺损的实验研究

目的:探讨用颧骨牵张成骨修复部分上颌骨缺损的可行性、科学性和规律性。方法:以犬建立实验动物模型,制造上颌骨颧突、颧骨节段性缺损,以内置式牵张成骨器牵张颧骨修复部分上颌骨,每次 1. 0mm, 1次 /d,连续 10d,共牵引 10mm,固定期X线观察。结果: 3只犬实验内容按计划完成,X线影像示,固定期 2周时,牵张间隙内早期骨结构形成,随后,骨密度进行性加强; 8周时,新生骨密度接近正常,与双侧正常骨质连续,骨缺损修复基本完成。结论:颧骨牵张成骨修复部分上颌骨具有临床应用可能性;颧骨牵张成骨实验动物模型切实可行,且受咬合力影响小,在某些领域可望获得更广泛的应用。     

颧骨内置弧线式骨牵张器的研制

目的研制颧骨内置弧线式骨牵张器,为实现颧骨弧线式牵张成骨提供器械。方法在干燥人体颅骨测量基础上,确定骨牵张器形态规格,并以钛合金材料制作完成,进一步利用人体干燥颅骨标本进行体外模拟,考察器械的可行性。结果自行研制的颧骨内置弧线式骨牵张器小巧轻便,与人体颧骨、上颌骨区域骨性结构匹配性良好,可以实现颧骨移动盘的改向、弧线式牵引。结论本颧骨内置弧线式骨牵张器,结构简捷,小巧轻便,可望实现内置弧线式颧骨牵张成骨修复部分上颌骨缺损,其是否具备临床应用可能性,有待进一步实验验证。     

曲线牵张成骨的初步实验研究

目的:探讨下颌骨弧线式牵张成骨修复部分下颌骨缺损的可行性。方法:以3只大型成年犬建立实验动物模型,制造下颌骨节段性弧形缺损,植入自行研发的内置弧线式骨牵张器,牵引间歇期7 d,牵引速度0.5 mm×2次/d,固定期3个月,共牵引约30 mm,采用大体观察、X线以及组织学观察其成骨特点。结果:实验过程中无感染等不良并发症,球形传力内置弧线式骨牵张器固位始终良好,大体观察可见骨呈现弧形愈合良好,X线影像显示:牵引结束时,骨移动盘实现显著的改向、内旋的曲线移动,与远端下颌骨呈弧线连接,HE染色显示出明显的新骨形成带。结论:球形挤压传力内置弧线式骨牵张器能够实现下颌骨后段弧线式牵张成骨。     

犬颧骨牵张成骨后种植体植入时机的实验研究

目的:研究颧骨牵张成骨效果,探讨种植体植入时机。方法:以6只犬为实验动物,制造上颌骨颧突节段性缺损,模拟上颌骨大型缺损,施行颧骨牵张成骨,每次1.0mm,每日1次,连续10天,共牵引10mm,固定期X线观察,分别于8、12、16周取材,行骨密度分析、大体标本、组织学观察。结果:6只犬实验内容按计划完成,牵张区新骨生成顺利,快速,于固定期8周时,新骨形成良好,但骨质结构、密度和成熟状况与正常骨相比尚存在一定差距,此后,各项指标进行性加强,至16周时,新生骨骨质结构已接近于正常骨,并具备相当的密度。结论:颧骨牵张成骨在固定期8周时,新生骨生成良好,骨缺损修复基本完成,此后,骨质不断改建和成熟,骨密度进行性加强,固定期16周时,新生骨在成熟状况,厚度、密度等方面接近于正常骨。固定期8-12周时可考虑种植体植入。     

内置弧形牵张成骨修复下颌骨缺损的临床应用

目的探讨应用内置弧形牵张成骨术修复下颌骨缺损的临床应用可能性。方法为一例炸伤致右下颌骨缺损的患者行内置弧形牵张成骨术。术中切除死骨,制作含C1、C2骨转移盘,可靠固定内置弧形骨牵张器,术后延迟一周行骨牵引,共牵引16d,固定期大体和全口曲面断层片考察新骨生成状况。结果治疗内容均按计划完成,牵引结束时,骨移动盘实现显著的改向、内旋,弧形牵引约15mm,固定期2周时,间隙内早期骨结构形成,由X线片可知,随后,骨密度逐渐升高,8周时,新生骨与双侧正常骨质连续,骨密度接近于双侧正常骨,内置弧形牵张成骨修复下颌骨缺损基本完成。结论内置弧形牵张成骨修复下颌骨缺损和本文报告的内置弧形骨牵张器具有临床应用可能性。     

颧骨弧形传输牵引修复部分上颌骨缺损的人体模拟研究

目的:考察自行研制的颧骨内置弧形骨牵张器的临床应用可能性。方法:自行研制的颧骨内置骨牵张器,主要由柔性中心螺杆和弧形轨道组成,在1例人体干燥颅骨标本上以该牵张器进行弧形颧骨弧形传输牵引修复上颌骨缺损的人体模拟研究。首先,切除20mm宽的上颌骨颧突以模拟上颌骨缺损,然后在缺损区后外侧制作宽10mm的骨转移盘并安置骨牵张器。随后,以加力杆旋转中心螺杆,使骨转移盘沿弧形轨道运动。结果:颧骨内置弧形骨牵张器与人体颧骨、上颌骨区域骨性结构匹配性良好,颧骨转移盘在该牵张器作用下,弧形运动约20mm到达预定部位。结论:颧骨内置弧形骨牵张器可以完成弧形牵引颧骨,替代部分上颌骨,在缺损侧重建骨性支持结构的任务。     

颊脂垫瓣在覆盖颧骨内置牵张器中的临床应用

目的:探讨带蒂颊脂垫瓣在颧骨内置弧形牵张成骨术中,用于覆盖骨牵张器的临床应用可能性。方法:为1例行“右上颌骨全切术+左上颌骨次全切除术”的患者行颧骨内置弧形牵张成骨术,术中行带蒂颊脂垫瓣移植覆盖骨牵张器底面。术后延迟1周行骨牵引,共牵引3周,在此过程中观察颊脂垫瓣状况。结果:颧骨内置弧形骨牵张器被颊脂垫瓣及缺损区邻近剩余软组织完整覆盖,与口腔完全隔离。颊脂垫瓣术后状况良好,在牵引过程中,无破裂、感染,未见骨牵张器暴露及骨转移盘穿出。术后4周时,颊脂垫瓣表面实现上皮化,与正常黏膜难以区分。结论:带蒂颊脂垫瓣移植可以完成在颧骨内置弧形牵张成骨术中覆盖骨牵张器的任务,并具备简单、便捷、微创、效果可靠等优点,值得推广。     

内置式曲线牵张器修复下颌角缺损的实验研究

目的:探讨自行设计的曲线牵张器修复下颌角弧形骨质缺损的可行性,曲线式牵张成骨的方式及其特点。方法:山羊4只,建立左侧下颌角弧形缺损的动物模型,制造骨转移盘,用自行设计的内置式曲线牵张器行BDO整复,牵引过程中摄X线片,进行骨密度测定,观察牵引进度及牵引间隙的成骨情况。结果:4只山羊中1只术后第3 d死亡,1只在牵引的末期牵引钢丝折断,2只顺利完成牵引,X线观察及骨密度测定见骨转移盘成功地沿预定的路径被牵引至缺隙的另一侧,固定2个月后牵引间隙的骨质已经与正常骨质的密度无显著性差异。结论:自行设计的内置式曲线牵张器可以完成下颌角弧形骨质缺损的修复。     

Evaluation of a new semiburied curvilinear distraction device in dogs

We developed a semiburied, curvilinear distraction device for use in osteogenesis in the reconstruction of maxillofacial defects. The device was tested in two dogs, which had segmental defects made in the maxilla and zygoma. The residual zygoma was distracted with the device. The bony transport discs were distracted about 12mm around an arc, and the new bone formed well in the distracted gap. The semiburied curvilinear distraction device has proved to be reliable for internal curvilinear distraction. Its clinical applicability needs to be studied further.     

Maxillary distraction using a trans-sinusal distractor: technical note

In this pilot study, the principle of distraction osteogenesis was used to advance the midface of a boxer dog. A modified high Le Fort I-type osteotomy was performed. Following a latency period of 5 days the maxilla was distracted 14 mm in 14 consecutive days at a rate of 1 mm per day. Ten weeks after the completion of the distraction, multiple biopsies were taken across the distraction gap. Histological observation showed bone deposition in the osteotomy sites. Soft and hard tissue formation resulted in complete healing across the distraction gap. The maxillary sinus was used to accommodate the distraction device. Superimposition of the standardized lateral cephalograms taken at the end of distraction and 14 months after the removal of the distractors showed no sign of relapse in the achieved sagittal advancement of the maxilla. This small, intraoral trans-sinusal placed distractor has a completely new conceptual design, and may be helpful in distraction of maxilla in children and adults with midfacial hypoplasia.     

Multiplanar and combined distraction osteogenesis for three-dimensional and functional reconstruction of unilateral large maxillary defects

We have developed a new way of three-dimensional and functional reconstruction of unilateral large maxillary defects by multiplanar and combined distraction osteogenesis of the zygoma, maxillary alveolar process, and hard palate. In the first procedure we started the internal curvilinear distraction osteogenesis of the left zygoma in one patient who had had a left maxillectomy to rebuild midfacial bony support. In the second procedure, the internal curvilinear distraction osteogenesis of the maxillary anterior alveolar process and straight distraction osteogenesis of the right hard palate were used to restore the posterior alveolar process and left palate. In the third procedure, the distracted zygoma and alveolar process were connected by a small local bone graft. The important lost maxillary bony architecture was re-established three-dimensionally and resulted in a natural facial appearance, normal speech and swallowing, and good foundation for chewing. This may be the first example of three-dimensional and functional reconstruction of unilateral large maxillary defects that did not require bone grafts from other anatomical areas.