涉及下颌骨体部和升支部缺损的定向二次牵引成骨治疗

目的探讨分期牵引成骨技术在下颌骨体部和升支部同期缺损修复中的应用方法及临床意义。方法对2001～2006年就诊的因各种原因导致下颌骨体部和升支部同期缺损患者12例,应用计算机辅助设计制作三维头颅模型,在模型上进行牵引成骨设计,预制个性化内置式颌骨牵引器,先期完成下颌体部及角部牵引,Ⅱ期完成下颌升支牵引。结果①下颌体及角部牵引长度4.5 cm～6.0 cm,平均5.2 cm;下颌升支牵引长度4.0 cm～6.0 cm,平均5.4 cm。②创口I期愈合,下颌外形良好,无感染等情况发生,下颌体及升支部成骨良好,健侧咬颌关系无偏斜。③平均追踪37.8个月,面下1/3外形恢复良好,张口度正常,咬合关系正常,牵引器放置软组织区无红肿等炎症表现。结论三维头颅模型为下颌骨体部和升支部同期缺损分期牵引成骨修复提供了精细的设计和操作平台,分期牵引成骨修复下颌骨体部和升支部同期缺损疗效确切。

The treatment of traction osteogenesis on major mandibular defects

Objective To study the application and clinical significance of the stage distraction osteogenesis in repairing homeochronous deficiency of mandibular body and mandibular ramus.Methods Twelve patients with homeochronous deficiency of mandibular body and mandibular branch caused by various reasons,visited in 2001～2006.Made their dimensional skull models by computer-assisted design,and did distraction osteogenesis design on the models,prepared personalized internal mandibular distraction device,completed distraction of mandibular body and angle in the first stage,and finished distraction of mandibular ramus in Ⅱ stage.Results ①The distraction length of mandibular body and angle was 4.5cm～6.0cm,average 5.2cm;The distraction length of mandibular ramus was 4.0cm～6.0cm,average 5.4cm.②The wound healed well in I stage,mandibular shape was good,no infection and other conditions occurred,the osteogenesis of mandibular body and mandibular ramus was good,and the contralateral occluding relation was no deviation.③Average follow-up 37.8 months,the appearance of 1/3 bottom facial recovered well,mouth opening was normal,the occluding relation was normal,no swelling and other inflammation conditions occurs in the soft tissue area where placed the retractors.Conclusion The dimensional skull models provide precise designs and operating platforms for repairing homeochronous deficiency of mandibular body and mandibular ramus.And the curative effects of the stage distraction osteogenesis in repairing homeochronous deficiency of mandibular body and mandibular ramus are confirmed.