应用牵引成骨技术治疗中面部骨发育不良畸形

目的 探讨牵引成骨技术对因多颅缝早闭所致的中面部发育不良综合征的治疗效果。方法 冠状切口径路,先用LeFort Ⅲ型截骨法在眶面部截骨,使颅底和中面部先行离断,安装外置REDⅡ式中面部牵引器。术后5d开始牵拉,每天1mm牵拉前移;待中面部到达良好位置和咬合关系时,停止牵拉,并固定该装置2～4个月。结果 完成的8例患者平均手术时间3．5h,术中平均失血300ml,中面部平均前移9．0mm,下移1．5mm;术后面部外形明显改观,咬合关系接近正常;除1例固定脚处的头皮感染和1例头皮血清肿外,术后无严重并发症发生;平均随访5个月,无面部后缩等复发症状。结论 牵引成骨技术可有效治疗学龄儿童和畸形严重的中面部骨发育不良畸形。

Surgical correction of craniofacial dysostosis with midface distraction osteogenesis

OBJECTIVE: To investigate the effect of distraction osteotogenesis on correction of craniofacial dysostosis. METHODS: Le Fort III osteotomy was applied through coronal route on patients with craniofacial dysostosis such as Crouzon and Apert syndrome. The procedures included disconnecting the skeletal midface from base of cranium, setting up a RED II distraction device, and directing the device bars. The distraction was started 5 days after the surgery, with a rate of 1 mm forward per day. When midface approaching the right position, i.e. a slightly over correction of occlusion was reached, stopped distraction and kept the device for 2 - 4 months. RESULTS: Eight cases completed all the therapy. The average blood lose was 300 ml and the average operation time was 3.5 hours. The midface had been moved averagely 9 mm forwardly and 1.5 mm downwardly. The features had been improved obviously and the occlusion reached nearly normal. No serious complications occurred except for 1 case of seroma and 1 case of infection around pin on scalp. No recurrence was found in the 5 months of follow-up. CONCLUSIONS: Midface distraction osteogenesis is propitious to teenage or severe cases of craniofacial dysostosis.