小切口Le FortⅢ型截骨治疗面中部发育不全  

Application of Le Fort Ⅲ osteotomy with minimal invasive approach in the treatment of midfacial hypoplasia

作　　者：王瑞晨[1] 柳春明[1] 高全文[1] 侯敏[1] 梁立民[1] 姚玉胜[1] 马骁[1] 金增强[1] 常世民[1] 

机构地区：[1]解放军总医院整形修复科,北京100853

出　　处：《中华整形外科杂志》2016年第2期93-97,共5页Chinese Journal of Plastic Surgery

基　　金：北京市自然科学基金（7072075）

摘　　要：目的探讨经小切口行LeFortⅢ型截骨术矫正面中部发育不全的临床应用。方法2001年6月至2015年2月，对33例面中部发育不全患者，分别经上睑皱褶内侧半切口、眉内近中侧切口或上睑弧形切口，结合睑缘下切口和口内上颌龈颊沟切口，切开后于骨膜下剥离显露截骨线并依序截骨，使用上颌骨把持钳折断面中部骨段。根据术前设计，安装颅骨外固定牵引器行牵引成骨术，或即刻前徙面中部骨段、植骨及坚固内固定手术。结果所有患者面中部骨段获得足够距离前徙，术中出血量和手术时间较冠状切口减少，术后瘢痕不明显。x线头影测量侧位片显示上颌骨的上牙槽座点前徙距离为7．2～20．7mm，平均12．4mm。术后随访0．5—8年，平均5．4年，患者术后容貌明显改善，侧貌正常，鼻梁及鼻下部挺拔，上唇丰满；突眼明显减轻，无复视、视物异常或眼睑功能异常；张闭口运动正常。结论小切口可以实现LeFortⅢ型截骨及相关的牵引或正颌手术操作，术中出血少，术后切口瘢痕轻微，前徙效果稳定。Objective To describe a minimal invasive approach in the Le Fort Ⅲ osteotomy procedure. Methods 33 eases with midfacial hypoplasia were treated by Le Fort Ⅲ osteotomy. Incisions were performed with minimal invasive approach, through lower eyelid, intraoral and upper eyelid crease or medial part of eyebrow instead of coronal incision. After the completion of osteotomy, distraction osteogenesis or orthognathic procedures were followed. Results The midfacial segments achieved enough advancement without obvious relapse. Bleeding and operative time were reduced compared with coronal approach. No obvious scar was left. Conclusions The Le Fort Ⅲ osteotomy procedure could he successfully performed through minimal approach with steady results and minimal scars.

关 键 词：截骨术 勒福 颅面骨发育不全 骨生成 牵张 外科手术 微创性 

分 类 号：R782[医药卫生—口腔医学]