内置式下颌骨牵引成骨术的早期并发症及防治

目的 总结内置式下颌骨牵引成骨术(DO)术中和术后早期并发症，探讨其有效防治方法。方法 对1997年11月～2002年12月间应用DO治疗的48例(83侧)下颌骨畸形或缺损患者进行分析。其中颞下颌关节强直伴小颌畸形双侧13例、单侧9例，下颌骨发育不足或小颌畸形14例，第一、二鳃弓综合征单侧5例、双侧1例，爆炸伤或肿瘤术后缺损畸形5例，Treacher Colins综合征1例，伴睡眠呼吸暂停综合征(OSAHS)者19例。所有病例均采用口内或(联合)口外切口并应用内置式牵引器。总结自施行手术开始至牵引完成期间的并发症及处理措施。结果 6例患者出现术中或术后早期并发症，发生率为12．5％，其中牵引机械装置故障2例，骨皮质切开术不彻底1例，早期感染1例，前牙严重开He1例，牵引早期疼痛剧烈1例，积极处理后均达到预期治疗目的。结论 减少DO术中及术后早期并发症的关键在于充分理解下颌骨牵引成骨术的机理，熟悉掌握下颌骨及邻近解剖结构，熟练操作规范，充分的术前准备和术后护理尤为重要。

Prevention and Management of Early Complications Following Mandibular Distraction Osteogenesis Using Internal Distractor

Objective To summarize early complications following mandibular distraction osteogenesis using internal distractor,in order to find effective methods for prevention and management.Methods Forty eight patients(seventy eight sides)suffering from malformations or defects of mandible who underwent mandibular DO respectively at our institute from December 1997 to December 2002 were retrospectively analyzed. The underlying diseases included bilateral temporomandibular joint (TMJ) ankylosis, accompanying micrognathia in 13 cases,unilateral TMJ ankylosis accompanying micrognathia in 9 cases,congenital or postnatal mandibular hypoplasia in 14 cases,unilateral first and second branchial syndrome in 5 cases,bilateral first and second branchial syndrome in 1 case,traumatic or postoperative mandibular defects in 5 cases, Treacher Colins syndrome in 1 case,19 patients had obstructive sleep apnea-hypopnea syndrome (OSAHS). All patients underwent corticotomy and rigid fixation of internal distractor through intraoral and/or extraoral incision.Results Early complications occurred in 6 patients,the incidence was 12.5%. 2 patients had complications associated with distractors, incomplete corticotomy occured in 1 case,1 patient had early infection,severe apertognathia of anterior teeth in 1 case, severe pain during early distraction in 1 case.Six cases underwent aggressive management and obtained satisfactory results.Conclusion The keys to reduce early complications are to understand the mechanism of mandibular DO completely and be familiar with the anatomy of mandible and adjacent tissues.It is necessary to preoperative preparation and postoperative care.