基于数字化技术的改良牵引成骨术整复半侧颜面短小畸形及疗效评估  

Reconstructive plastic surgery of hemifacial microsomia by using modified distraction osteogenesis and appraisal of the surgical outcome based on digital techniques

作　　者：杨斌[1] 李秉航[1] 丁榆德 倪健[1] 黄庆华[1] YANG Bin LI Bing-hang DING Yu-de NI Jian HUANG Qing-hua.(The Maxillofacial Surgery Department, Digital Plastic Center, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100144, China)

机构地区：[1]中国医学科学院北京协和医学院整形外科医院颌面整形外科中心数字化整形中心,北京100144

出　　处：《中国美容整形外科杂志》2016年第12期708-712,共5页Chinese Journal of Aesthetic and Plastic Surgery

基　　金：国家卫生和计划生育委员会公益性行业科研专项(201502016);北京市科技计划首都临床特色应用研究(Z151100004015056)

摘　　要：目的探讨在数字化技术的支持下,应用结合下颌升支矢状劈开截骨术的改良内置式牵引成骨技术,治疗半侧颜面短小畸形的方法及临床效果。方法术前进行数字化手术模拟,明确下颌神经管与恒牙胚的位置,设计截骨线及牵引器固定位置。术中根据方案,采用改良的截骨术式进行截骨,即刻进行牵引,术后进行快速牵引,直至达到预期的延长效果。术后复查CT,进行面部三维重建和软组织三维扫描,测量健、患侧骨组织及软组织数据,并对手术前后各测量数据进行比较。结果 10例患者术后面部垂直方向的对称性得到较大程度的改善,牙平面较术前趋于水平,未发生神经及牙胚损伤等并发症;外观及咬功能基本正常,术后患侧下颌升支长度及厚度比术前明显增加,骨组织及软组织对称性改善明显。结论应用下颌升支矢状劈开截骨行牵引成骨的方法,能提高手术安全性,避免损伤神经及牙胚,并且能加快牵引速率,缩短疗程,并发症较少,能够安全有效地矫治半侧颜面短小畸形的颌骨不对称。Objective To explore the method and clinical effect of modified internal fixation osteotomy combined with sagittal split ramus osteotomy of mandibular ramus in the treatment of hemifacial malformation with digital technique to improve the surgical outcome. Methods 10 cases with hemifacial microsomia were included in this study. Preoperatively, we designed the osteotomy line and marked the location of the mandibular canal and the tooth germ in a three-dimensional reconstrueion model. Sagittal split osteotomy was combined with intraoral distraction osteogenesis in surgery, in order to avoid the damage of inferior alveolar nerve and artery, as well as permanent tooth germ. When the distractor was placed in the right position, we extended 2 to 4 mm during the operation. The distraction started 3 to 5 days after the operation with a rate of 1 to 2 mm a day, until the mandibular ramus reached the expected length. The 10 cases were followed up by CT scan and three-dimensional reconstruction. Lastly, we measured the length of the mandibular ramus of both the healthy and affected sides and compared the preoperation data to postoperative data quantitatively. Results All 10 patients underwent rapid distraction after surgery. The longest was 20 mm and the shortest was 7 mm. Facial symmetry of all patients was obviously improved in the vertical direction and the oeclusal plane tended to be normal without severe complications. Appearance and dental occlusion in all patients became basically normal within 1 to 2 years follow-up and there was statistical difference （ P 〈 0.05 ） in the mandibular ramus length of the affected side between preoperation and postoperation. Conclusion Using sagittal split osteotomy in mandibular distraction osteogenesis based on digital technique can accelerate the distraction rate, shorten the course of treatment and extend the mandible, both in width and thickness, which can reduce the incidence of complications usually caused by traditional distraction osteogenesis, improve the treatment effe

关 键 词：半侧颜面短小畸形 矢状劈开截骨术 牵引成骨 计算机辅助设计 数字化3D打印 

分 类 号：R782.2[医药卫生—口腔医学]