下颌支矢状劈开术不同固定方式对下牙槽神经结构的影响  

Effects of rigid internal fixation on the inferior alveolar nerve following sagittal split of ramus osteotomy in monkeys

作　　者：赵强[1] 胡静[1] 王大章[1] 李继华[1] 祝颂松[1] 罗恩[1] 

机构地区：[1]四川大学华西口腔医学院口腔颌面外科,四川成都610041

出　　处：《中国口腔颌面外科杂志》2007年第2期135-138,共4页China Journal of Oral and Maxillofacial Surgery

基　　金：教育部跨世纪人才基金(教技函2002-48)

摘　　要：目的:对比观察下颌支矢状劈开术(sagittal split ramus osteotomy,SSRO)2种内固定方式术后不同时期下牙槽神经(inferior alveolar nerve,IAN)结构的改变,为临床SSRO手术选择内固定方式提供实验依据。方法:选用成年恒河猴12只,全麻下行SSRO后退双侧下颌骨,左、右侧分别行双皮质螺钉固定及单皮质微型夹板固定。术后4、12周时各随机处死6只恒河猴,制作双侧IAN半薄和超薄切片,光镜和透射电镜下观察其结构变化。另选取2只成年恒河猴作为正常对照。应用SPSS11．5统计软件包进行方差分析,组间比较采用q检验。结果:术后4周,所有动物的IAN均出现轻中度Wallerian变性(P=0．000),但同时发现神经轴突再生。在2种固定方式中,术后4周双皮质固定组IAN的病理改变较单皮质固定组重(P=0．02),且单皮质固定组显示出更早和更快的神经再生现象。结论:SSRO结合坚强内固定术对IAN的结构形态均有一定影响,但单皮质固定较双皮质固定对IAN的影响较小,受损神经的恢复再生速度更快。PURPOSE： To evaluate the effect of two kinds of rigid internal fixation on the structure of the inferior alveolar nerve （IAN） following sagittal split of ramus osteotomy （SSRO） in a rhesus model. METHODS： 12 adult male rhesus monkeys underwent bilateral SSRO to set back the mandible. Monocortical （with miniplate） and bicortical screws fixation were applied on the opposite sides of the mandibles. Six animals selected randomly were sacrificed at 4 and 12 weeks after operation, respectively. The nerve specimens were harvested and processed for histologic and electron microscopic analysis. ANOVA was used for data analysis by SPSS11.5 software package, and q test was used for analyzing the difference between the groups. RESULTS： Wallerian degeneration and axonal loss were observed in the nerves of the operated animals at 4 weeks after surgery （P=0.000）, and axonal regeneration changes were also noted in the injured nerves. However, the IAN from bicortical fixation side had more serious pathologic changes when compared with the nerve from monocortical fixation side 4 weeks after surgery （P=0.02）. Although a recovery tendency was found on both sides at 12 weeks postoperatively, the nerves in monocortical fixation side still showed earlier and better restoration of neural structures. CONCLUSION： SSRO with internal rigid fixation may led to injury of the IAN, but the monocortical fixation led to less damage than the bicortical fixation, and quicker restoration in the neural structures. Supported by a grant from Trans-Century Training Program, Foundation for the Talents by the Ministry of Education of China （Grant No.2002-48）.

关 键 词：下颌支矢状劈开术 坚强内固定 下牙槽神经 恒河猴 

分 类 号：R782.23[医药卫生—口腔医学]