骨缝牵引成骨修复腭裂的临床初步研究

目的 临床探索骨缝牵引成骨修复腭裂的新技术。方法 选择2～4岁的腭裂患儿。一期手术在全麻下安置腭裂牵引器，牵引腭骨向中线和向后移动；牵引期持续约4～5个月。裂隙合拢后进行二期手术，修复裂隙。用误差为0．2％的游标卡尺，测量牵引前和牵引后上颌牙弓宽度、裂隙宽度和硬腭长度。结果 临床应用8例。2例因牵引器在安置后l周内脱落而终止牵引。6例经不同时间的牵引后，裂隙缩小，裂隙两侧的组织显著延长。其中牵引时间最长为126d，最短为37d；裂隙宽度平均缩小6．5mm；硬腭长度平均延长4．8mm。结论 临床证实了骨缝牵引具有诱导腭部组织再生、关闭或缩小裂隙和延长硬腭的可能性。

Sutural distraction osteogenesis for primary cleft palate repair:a preliminary clinical report

Objective To probe the possibility of a new technique of primary cleft palate repair by sutural distraction osteogenesis. Methods The distractor was made of TiNi-shape memory alloy with 2 secure and 2 active arms.Under general anesthesia,1 hole was drilled on each maxillary process and horizontal plate of palatine.The four arms of the distractor were inserted into holes.The palatine bones would then be distracted and moved medially and posteriorly.After 4 to 5 months' distraction,the two cleft edges approached gradually.The residual cleft,according to its width,was repaired by direct stitch of muco-periosteum incised at cleft edges,or with an additional relaxing incision on one side of the palate.Direct measurement of width of maxillary arch and the cleft,and the length of the hard palate was performed before and after distraction to evaluate the effects of distraction. Results Eight cleft children at their 2 to 4 years of age were treated by the new technique.Two of them terminated the procedure due to premature dislocation of the distractor.Six children underwent 37 to 126 days'distraction.Dramatic narrowing of the cleft and lengthening of hard palate were seen in these children,with the average narrowing of the cleft being 6 5mm and average lengthening of the hard palate being 4 8mm. Conclusion It is clinically demonstrated that palatal tissue regeneration and cleft closure or narrowing and hard palate lengthening could be achieved by the technqiue of sutural distraction osteogenesis.;